Provider Demographics
NPI:1487682837
Name:GADOUA, MARC (L AC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GADOUA
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 NE 12TH
Mailing Address - Street 2:#205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-872-9861
Mailing Address - Fax:503-232-7440
Practice Address - Street 1:407 NE 12TH
Practice Address - Street 2:#205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-872-9861
Practice Address - Fax:503-232-7440
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLAC00208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist