Provider Demographics
NPI:1346065075
Name:TRACY ANDERSEN, DAOM, LAC
Entity type:Organization
Organization Name:TRACY ANDERSEN, DAOM, LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:503-250-3012
Mailing Address - Street 1:2301 NW THURMAN ST STE O
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2581
Mailing Address - Country:US
Mailing Address - Phone:503-250-3012
Mailing Address - Fax:503-208-8028
Practice Address - Street 1:2301 NW THURMAN ST STE O
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2581
Practice Address - Country:US
Practice Address - Phone:503-250-3012
Practice Address - Fax:503-208-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty