Individual
TRISTA L. JOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAOM, L.AC.
Contact information
Practice address
3234 NE WASCO ST, PORTLAND, OR 97232-1981
(503) 703-3197
Mailing address
1142 SE 52ND AVE, PORTLAND, OR 97215-2633
(503) 703-3197
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01171
OR
Other
Enumeration date
02/09/2008
Last updated
02/09/2008
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