Provider Demographics
NPI:1275865990
Name:MOELLER, DAWN C (LAC)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:C
Last Name:MOELLER
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 1:3758 SE TWELVE OAKS ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-9206
Mailing Address - Country:US
Mailing Address - Phone:503-688-0648
Mailing Address - Fax:
Practice Address - Street 1:10211 SW BARBUR BLVD STE 205A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5935
Practice Address - Country:US
Practice Address - Phone:503-688-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR152896171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist