Provider Demographics
NPI:1083769541
Name:MARSHALL, JANET LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 SE OAK GROVE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1300
Mailing Address - Country:US
Mailing Address - Phone:503-794-9299
Mailing Address - Fax:
Practice Address - Street 1:2905 SE OAK GROVE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-1300
Practice Address - Country:US
Practice Address - Phone:503-794-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR80-0026841OtherEIN