Provider Demographics
NPI:1508808627
Name:SLOSBERG, JOHN CHARLES (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:SLOSBERG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3272 NE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3243
Mailing Address - Country:US
Mailing Address - Phone:503-320-1342
Mailing Address - Fax:503-331-0164
Practice Address - Street 1:2121 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1522
Practice Address - Country:US
Practice Address - Phone:503-320-1342
Practice Address - Fax:503-234-9639
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist