Provider Demographics
NPI:1841413812
Name:HARD, KIP MARILYN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:KIP
Middle Name:MARILYN
Last Name:HARD
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 NE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3150
Mailing Address - Country:US
Mailing Address - Phone:503-230-0812
Mailing Address - Fax:
Practice Address - Street 1:316 NE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3150
Practice Address - Country:US
Practice Address - Phone:503-230-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1670111N00000X
ORAC00351171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor