Provider Demographics
NPI:1184045882
Name:DR SIEGEL LLC
Entity Type:Organization
Organization Name:DR SIEGEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:503-274-9360
Mailing Address - Street 1:838 SW 1ST AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3328
Mailing Address - Country:US
Mailing Address - Phone:503-274-9360
Mailing Address - Fax:503-274-9370
Practice Address - Street 1:838 SW 1ST AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3328
Practice Address - Country:US
Practice Address - Phone:503-274-9360
Practice Address - Fax:503-274-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherTAX ID