Provider Demographics
NPI:1962944744
Name:ALLENTON, ELECTRA L (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:ELECTRA
Middle Name:L
Last Name:ALLENTON
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 1:2301 NW THURMAN ST.
Mailing Address - Street 2:SUITE S
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2581
Mailing Address - Country:US
Mailing Address - Phone:503-459-9596
Mailing Address - Fax:888-528-4439
Practice Address - Street 1:2301 NW THURMAN ST.
Practice Address - Street 2:SUITE S
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2581
Practice Address - Country:US
Practice Address - Phone:503-459-9596
Practice Address - Fax:888-528-4439
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC180420171100000X
OR4064175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1962944744Medicaid