Provider Demographics
NPI:1619664281
Name:RICHMOND, ROD FREDERICK (LAC)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:FREDERICK
Last Name:RICHMOND
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 1:7709 SW PFAFFLE ST APT 84
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2403
Mailing Address - Country:US
Mailing Address - Phone:808-443-7354
Mailing Address - Fax:
Practice Address - Street 1:9600 SW OAK ST STE 410
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6581
Practice Address - Country:US
Practice Address - Phone:503-308-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC210861171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty