Provider Demographics
NPI:1205173671
Name:GREGORY, STEPHEN (LAC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GREGORY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3710 SW U.S. VETERAN'S HOSPITAL RD
Mailing Address - Street 2:ATTN: STEPHEN GREGORY CP3ANES
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-893-5711
Mailing Address - Fax:
Practice Address - Street 1:3710 SW U.S. VETERAN'S HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC159857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist