Provider Demographics
NPI:1477511731
Name:CHODOSH, LOWELL MARK (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:MARK
Last Name:CHODOSH
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7633 SW ALOMA WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7936
Mailing Address - Country:US
Mailing Address - Phone:503-816-9843
Mailing Address - Fax:
Practice Address - Street 1:2332 NW IRVING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3225
Practice Address - Country:US
Practice Address - Phone:503-222-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00314171100000X
OR0770175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist