Provider Demographics
NPI:1891168399
Name:NORTHROP, J WHISKEY (LAC)
Entity type:Individual
Prefix:
First Name:J
Middle Name:WHISKEY
Last Name:NORTHROP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:WHISKEY
Other - Middle Name:
Other - Last Name:NORTHROP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:411 NE 57TH AVE
Mailing Address - Street 2:APT B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3789
Mailing Address - Country:US
Mailing Address - Phone:503-701-6077
Mailing Address - Fax:503-776-3106
Practice Address - Street 1:6118 SE BELMONT ST STE 405
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1983
Practice Address - Country:US
Practice Address - Phone:503-701-6077
Practice Address - Fax:503-776-3106
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC173827171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500704599Medicaid