Provider Demographics
NPI:1063790525
Name:GIVENS, MICHAEL E (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:GIVENS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:CORBETT
Mailing Address - State:OR
Mailing Address - Zip Code:97019-8606
Mailing Address - Country:US
Mailing Address - Phone:971-227-3898
Mailing Address - Fax:
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:STE.101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-701-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist