Individual
MICHAEL THOMAS LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
3615 NE GRAND AVE, PORTLAND, OR 97212-2104
(503) 208-5460
Mailing address
3615 NE GRAND AVE, PORTLAND, OR 97212-2104
(503) 208-5460
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
156585
—
Other
Enumeration date
11/08/2011
Last updated
11/08/2011
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