Provider Demographics
NPI:1437221991
Name:BROTHER, MARTIN ALLEN (LAC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ALLEN
Last Name:BROTHER
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 1:19810 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4812
Mailing Address - Country:US
Mailing Address - Phone:503-650-9070
Mailing Address - Fax:503-650-9070
Practice Address - Street 1:1785 WILLAMETTE FALLS DR
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4568
Practice Address - Country:US
Practice Address - Phone:503-723-0394
Practice Address - Fax:503-650-9070
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist