Provider Demographics
NPI:1528332236
Name:BALOGH, MICHAEL (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BALOGH
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 1:6225 SW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4461
Mailing Address - Country:US
Mailing Address - Phone:503-515-4457
Mailing Address - Fax:503-277-2245
Practice Address - Street 1:6225 SW WILSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4461
Practice Address - Country:US
Practice Address - Phone:503-515-4457
Practice Address - Fax:503-277-2245
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156571171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist