Organization
ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN KAREN ISAKSON LAC (MANAGING MEMBER)
(971) 229-2140
Entity
Organization
Contact information
Practice address
4035 SE 52ND AVE STE B, PORTLAND, OR 97206-3913
(503) 482-7556
(971) 244-9171
Mailing address
4035 SE 52ND AVE STE B, PORTLAND, OR 97206-3913
(971) 229-2140
(971) 244-9171
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
—
—
175F00000X
Naturopath
—
—
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
225700000X
Massage Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932568458
NPI TYPE 1
—
05
—
500703138
—
OR
Enumeration date
04/30/2019
Last updated
03/30/2022
Update your record
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