Provider Demographics
NPI:1164695698
Name:MAUREEN BECKER ND LAC PC
Entity Type:Organization
Organization Name:MAUREEN BECKER ND LAC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:ND LAC PC
Authorized Official - Phone:503-736-9900
Mailing Address - Street 1:5013 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3255
Mailing Address - Country:US
Mailing Address - Phone:503-736-9900
Mailing Address - Fax:
Practice Address - Street 1:5013 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3255
Practice Address - Country:US
Practice Address - Phone:503-736-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00137171100000X
OR0505175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119177 ORMedicaid