Provider Demographics
NPI:1083912919
Name:ARON, CASEY MATTHEW (LAC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MATTHEW
Last Name:ARON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 SE HAWTHORNE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3160
Mailing Address - Country:US
Mailing Address - Phone:503-233-4102
Mailing Address - Fax:
Practice Address - Street 1:4203 SE HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3160
Practice Address - Country:US
Practice Address - Phone:503-233-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist