Provider Demographics
NPI:1376768093
Name:CHAWLA, SHANNON EILEEN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:EILEEN
Last Name:CHAWLA
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 1:3430 SE BELMONT ST # 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4247
Mailing Address - Country:US
Mailing Address - Phone:503-232-7362
Mailing Address - Fax:
Practice Address - Street 1:3430 SE BELMONT ST # 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4247
Practice Address - Country:US
Practice Address - Phone:503-232-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00489171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist