Individual
SHADRACK MARVIN SANDVOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1954 SE 182ND AVE, PORTLAND, OR 97233-5602
(503) 667-8988
(503) 667-8988
Mailing address
1954 SE 182ND AVE, PORTLAND, OR 97233-5602
(503) 667-8988
(503) 667-8988
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5239
OR
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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