Provider Demographics
NPI:1851645121
Name:CHI, SUZANNE (LAC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CHI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 NE 15TH AVE
Mailing Address - Street 2:#512
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2356
Mailing Address - Country:US
Mailing Address - Phone:503-228-1306
Mailing Address - Fax:503-228-1307
Practice Address - Street 1:1515 NW 18TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2516
Practice Address - Country:US
Practice Address - Phone:503-228-1306
Practice Address - Fax:503-228-1307
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC160229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist