Provider Demographics
NPI:1225330210
Name:PISKER, ALEX ROBERT (LAC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:ROBERT
Last Name:PISKER
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 1:3175 SW WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4256
Mailing Address - Country:US
Mailing Address - Phone:303-260-9200
Mailing Address - Fax:
Practice Address - Street 1:130 NW MILLER AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7226
Practice Address - Country:US
Practice Address - Phone:303-260-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152736171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist