Individual
KEVI LYNN KEENOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC MACOM
Contact information
Practice address
4512 SE WOODSTOCK BLVD, PORTLAND, OR 97206-6274
(503) 777-2776
Mailing address
3905 SE 70TH AVE, PORTLAND, OR 97206-2525
(808) 386-2199
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC156429
OR
Other
Enumeration date
03/18/2012
Last updated
03/18/2012
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