Provider Demographics
NPI:1457682775
Name:HULLENDER RUBIN, LEE E (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:E
Last Name:HULLENDER RUBIN
Suffix:
Gender:F
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:PO BOX 11233
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-0233
Mailing Address - Country:US
Mailing Address - Phone:503-807-0158
Mailing Address - Fax:
Practice Address - Street 1:4534 NE CESAR E CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-8125
Practice Address - Country:US
Practice Address - Phone:503-807-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1879171100000X
CA18187171100000X
ORAC153822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist