Provider Demographics
NPI:1699810333
Name:NOLL, LAILA MARIE-NEMATBAKSH (DC)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:MARIE-NEMATBAKSH
Last Name:NOLL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 NW MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3295
Mailing Address - Country:US
Mailing Address - Phone:503-719-5335
Mailing Address - Fax:503-719-5334
Practice Address - Street 1:4847 MEADOWS RD 153
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2626
Practice Address - Country:US
Practice Address - Phone:971-330-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71 3715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor