Provider Demographics
NPI:1184669913
Name:ANDERSON, CYNTHIA J (LAC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 SW MACADAM AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3818
Mailing Address - Country:US
Mailing Address - Phone:503-684-9698
Mailing Address - Fax:
Practice Address - Street 1:5125 SW MACADAM AVE STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3818
Practice Address - Country:US
Practice Address - Phone:503-684-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00252171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist