Provider Demographics
NPI:1760857668
Name:VOELKER, SIBYL AMBER (LAC, MACOM)
Entity Type:Individual
Prefix:
First Name:SIBYL
Middle Name:AMBER
Last Name:VOELKER
Suffix:
Gender:F
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:SIBYL
Other - Middle Name:
Other - Last Name:LANTHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3529 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4254
Mailing Address - Country:US
Mailing Address - Phone:503-679-4128
Mailing Address - Fax:
Practice Address - Street 1:1235 SE DIVISION ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1099
Practice Address - Country:US
Practice Address - Phone:503-828-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC175010171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist