Individual
ANDREW WILDWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1540 SE CLINTON ST, PORTLAND, OR 97202-1130
(971) 319-0171
Mailing address
1540 SE CLINTON ST, PORTLAND, OR 97202-1130
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC181041
OR
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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