Provider Demographics
NPI:1649210881
Name:GALLISON, CHERI LORRAINE VII (LAC)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LORRAINE
Last Name:GALLISON
Suffix:VII
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CHERRI
Other - Middle Name:LORRAINE
Other - Last Name:GALLISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1509 SW SUNSET BLVD
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2692
Mailing Address - Country:US
Mailing Address - Phone:503-452-0224
Mailing Address - Fax:
Practice Address - Street 1:1509 SW SUNSET BLVD
Practice Address - Street 2:SUITE 1F
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2692
Practice Address - Country:US
Practice Address - Phone:503-452-0224
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00764171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist