Individual
LISA MARIE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1212 SE POWELL BLVD, SUITE C, PORTLAND, OR 97202-2460
(541) 556-3443
(954) 963-7169
Mailing address
1212 SE POWELL BLVD, SUITE C, PORTLAND, OR 97202-2460
(541) 556-3443
(954) 963-7169
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC00600
OR
Other
Enumeration date
12/29/2008
Last updated
12/29/2008
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