Provider Demographics
NPI:1306201744
Name:GOLD, COLIN (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:
Last Name:GOLD
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GREENRIDGE DR
Mailing Address - Street 2:APT. 1001
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8849
Mailing Address - Country:US
Mailing Address - Phone:504-875-9549
Mailing Address - Fax:
Practice Address - Street 1:200 GREENRIDGE DR
Practice Address - Street 2:APT. 1001
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8849
Practice Address - Country:US
Practice Address - Phone:504-875-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC165317171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist