Provider Demographics
NPI:1790823110
Name:HARTZELL, GREGORY AARON (LAC, MACOM,LMT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:AARON
Last Name:HARTZELL
Suffix:
Gender:M
Credentials:LAC, MACOM,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8535 SW SAGERT ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9115
Mailing Address - Country:US
Mailing Address - Phone:503-427-0545
Mailing Address - Fax:
Practice Address - Street 1:8575 SW SAGERT ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9115
Practice Address - Country:US
Practice Address - Phone:503-427-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00834171100000X
OR9292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist