Individual
ANTON SELIVONCHICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.AC.
Contact information
Practice address
2100 NE BROADWAY ST STE 225, PORTLAND, OR 97232-1544
(503) 490-6689
Mailing address
790 SE WEBBER ST UNIT 401, PORTLAND, OR 97202-7051
(503) 490-6689
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC157170
OR
Other
Enumeration date
07/20/2012
Last updated
07/20/2012
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