Individual
JOHN SHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
914 SW 11TH AVE, PORTLAND, OR 97205-2001
(503) 427-9358
Mailing address
2904 SE BELMONT ST APT 17, PORTLAND, OR 97214-4049
(818) 934-6062
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC186199
OR
Other
Enumeration date
06/15/2018
Last updated
06/15/2018
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