Provider Demographics
NPI:1548560956
Name:MCINTIRE, BOYNN F (LAC)
Entity Type:Individual
Prefix:
First Name:BOYNN
Middle Name:F
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SE 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1461
Mailing Address - Country:US
Mailing Address - Phone:503-281-6909
Mailing Address - Fax:
Practice Address - Street 1:5 SE 76TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1461
Practice Address - Country:US
Practice Address - Phone:503-281-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152777171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist