Provider Demographics
NPI:1053861245
Name:SELHORST, CHARLES CHRISTOPHER (RN, LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:SELHORST
Suffix:
Gender:M
Credentials:RN, LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE IVY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2038
Mailing Address - Country:US
Mailing Address - Phone:510-499-7115
Mailing Address - Fax:
Practice Address - Street 1:513 N MORRISON RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1432
Practice Address - Country:US
Practice Address - Phone:510-499-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60709575171100000X
CA378908163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse