Provider Demographics
NPI:1568892487
Name:HAWKINS, ABRAHAM (LAC)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7670 SW ALOMA WAY
Mailing Address - Street 2:APT. #3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7939
Mailing Address - Country:US
Mailing Address - Phone:503-545-1717
Mailing Address - Fax:
Practice Address - Street 1:8040 NE SANDY BLVD
Practice Address - Street 2:SUITE 100A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-7100
Practice Address - Country:US
Practice Address - Phone:503-841-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR164981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist