Provider Demographics
NPI:1073732616
Name:LENNON, AMY K (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:LENNON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1017
Mailing Address - Country:US
Mailing Address - Phone:503-231-9879
Mailing Address - Fax:503-233-4732
Practice Address - Street 1:1222 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1017
Practice Address - Country:US
Practice Address - Phone:503-231-9879
Practice Address - Fax:503-233-4732
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor