Provider Demographics
NPI:1225263700
Name:DAUMEN, JACOB ROBERT (LAC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ROBERT
Last Name:DAUMEN
Suffix:
Gender:M
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:PO BOX 66311
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97290-6311
Mailing Address - Country:US
Mailing Address - Phone:503-753-4313
Mailing Address - Fax:
Practice Address - Street 1:5802 SE POWELL BLVD # 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2826
Practice Address - Country:US
Practice Address - Phone:503-567-5586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00937171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist