Provider Demographics
NPI:1285699819
Name:SHAVER, LISA LOUISE (ND LAC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LOUISE
Last Name:SHAVER
Suffix:
Gender:F
Credentials:ND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SW YAMHILL
Mailing Address - Street 2:# 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2539
Mailing Address - Country:US
Mailing Address - Phone:503-222-1315
Mailing Address - Fax:503-222-1317
Practice Address - Street 1:1033 SW YAMHILL
Practice Address - Street 2:# 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2539
Practice Address - Country:US
Practice Address - Phone:503-222-1315
Practice Address - Fax:503-222-1317
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00885171100000X
OR1376175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath