Provider Demographics
NPI:1508071242
Name:MIDDELZICK, ANJA (LAC, LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANJA
Middle Name:
Last Name:MIDDELZICK
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:MRS
Other - First Name:ANJA
Other - Middle Name:
Other - Last Name:MIDDELVELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3880 SE HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:503-513-4665
Mailing Address - Fax:503-513-4663
Practice Address - Street 1:3880 SE HARRISON STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-513-4665
Practice Address - Fax:503-513-4663
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist