Individual
JONATHAN IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC.
Contact information
Practice address
2121 W BURNSIDE ST, PORTLAND, OR 97210-3519
(503) 432-8348
Mailing address
525 SE 41ST AVE APT 16, PORTLAND, OR 97214-3259
(206) 305-8709
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC184368
OR
Other
Enumeration date
10/23/2017
Last updated
07/01/2020
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