Individual
EVAN SPENCER STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC
Contact information
Practice address
2 NW 3RD AVE, PORTLAND, OR 97209-3907
(503) 841-6828
Mailing address
715 SW KING AVE APT 4, PORTLAND, OR 97205-1403
(540) 449-5664
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC153198
OR
Other
Enumeration date
09/25/2013
Last updated
09/25/2013
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