Individual
GENEVIEVE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
2161 NE BROADWAY, PORTLAND, OR 97232
(503) 679-3872
Mailing address
2161 NE BROADWAY ST, PORTLAND, OR 97232-1512
(503) 679-3872
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC156421
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC156421
OREGON MEDICAL BOARD
OR
Enumeration date
08/02/2017
Last updated
07/21/2022
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