Provider Demographics
NPI:1902064660
Name:ALLEN, GENEVIEVE MARIE (ND, LAC)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SE WASHINGTON ST
Mailing Address - Street 2:SUITE #134
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2103
Mailing Address - Country:US
Mailing Address - Phone:503-236-6633
Mailing Address - Fax:503-473-2974
Practice Address - Street 1:107 SE WASHINGTON ST
Practice Address - Street 2:SUITE #134
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2103
Practice Address - Country:US
Practice Address - Phone:503-236-6633
Practice Address - Fax:503-473-2974
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01172171100000X
OR1567175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath