Provider Demographics
NPI:1083749709
Name:FONTENOT, LINDSAY MARIE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:MARIE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 NE KILLINGSWORTH ST # 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2625
Mailing Address - Country:US
Mailing Address - Phone:503-307-9342
Mailing Address - Fax:503-285-0037
Practice Address - Street 1:1937 NE BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1586
Practice Address - Country:US
Practice Address - Phone:503-307-9342
Practice Address - Fax:503-217-6200
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1524175F00000X
ORAC01090171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist