Provider Demographics
NPI:1467161455
Name:THE MEND PDX LLC
Entity Type:Organization
Organization Name:THE MEND PDX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIZHENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:971-302-6176
Mailing Address - Street 1:4125 SE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3428
Mailing Address - Country:US
Mailing Address - Phone:415-690-0690
Mailing Address - Fax:
Practice Address - Street 1:1971 NW OVERTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1618
Practice Address - Country:US
Practice Address - Phone:971-302-6176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty