Provider Demographics
NPI:1164635561
Name:POLSON, JAN LINETTE (L,AC, DIPL AC)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:LINETTE
Last Name:POLSON
Suffix:
Gender:F
Credentials:L,AC, DIPL AC
Other - Prefix:MS
Other - First Name:JANN
Other - Middle Name:LINETTE
Other - Last Name:POLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, DIPL AC
Mailing Address - Street 1:8221 SE ASPEN SUMMIT DR.
Mailing Address - Street 2:# 11
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-9221
Mailing Address - Country:US
Mailing Address - Phone:503-481-5904
Mailing Address - Fax:
Practice Address - Street 1:6214 SE MILWAUKIE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-481-5904
Practice Address - Fax:503-233-8995
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist