Provider Demographics
NPI:1154469872
Name:TRUMBO, WARREN D (LAC)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:D
Last Name:TRUMBO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:WARREN
Other - Middle Name:
Other - Last Name:TRUMBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2216 SE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3827
Mailing Address - Country:US
Mailing Address - Phone:503-234-2539
Mailing Address - Fax:
Practice Address - Street 1:2216 SE 50TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3827
Practice Address - Country:US
Practice Address - Phone:503-234-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist