Provider Demographics
NPI:1932144771
Name:PHILLIPO, CARA M (ND LAC)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:M
Last Name:PHILLIPO
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 1:2002 SE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3823
Mailing Address - Country:US
Mailing Address - Phone:971-235-8615
Mailing Address - Fax:
Practice Address - Street 1:2401 SE 161ST CT
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5293
Practice Address - Country:US
Practice Address - Phone:360-882-1339
Practice Address - Fax:360-253-8006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002666171100000X
WANT00001392175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath