Provider Demographics
NPI:1902404833
Name:MAI, CINDY (ND, LAC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 NW QUIMBY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2622
Mailing Address - Country:US
Mailing Address - Phone:503-292-7668
Mailing Address - Fax:
Practice Address - Street 1:559 RAY J GLATT CIR #1
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-2622
Practice Address - Country:US
Practice Address - Phone:503-981-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
OR4332175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist