Provider Demographics
NPI:1821139668
Name:KANEKO, ROBERT T (LAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:KANEKO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 NE 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3948
Mailing Address - Country:US
Mailing Address - Phone:503-841-5991
Mailing Address - Fax:503-287-9899
Practice Address - Street 1:3024 NE 63RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4510
Practice Address - Country:US
Practice Address - Phone:503-287-9889
Practice Address - Fax:503-287-9899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00222171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist