Provider Demographics
NPI:1629375217
Name:MORTON, KERRY ERIN (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ERIN
Last Name:MORTON
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 SW 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2779
Mailing Address - Country:US
Mailing Address - Phone:503-277-1430
Mailing Address - Fax:503-350-1470
Practice Address - Street 1:12750 SW 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2779
Practice Address - Country:US
Practice Address - Phone:503-277-1430
Practice Address - Fax:503-350-1470
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR153716171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist