Provider Demographics
NPI:1144403254
Name:MELETHIL, PADMANABHAN K (L AC)
Entity Type:Individual
Prefix:
First Name:PADMANABHAN
Middle Name:K
Last Name:MELETHIL
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30150 SW PARKWAY AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6837
Mailing Address - Country:US
Mailing Address - Phone:503-682-9319
Mailing Address - Fax:
Practice Address - Street 1:30150 SW PARKWAY AVE STE 600
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6837
Practice Address - Country:US
Practice Address - Phone:503-682-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC1079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist