Provider Demographics
NPI:1245708908
Name:LYNCH, PATRICK AARON (LAC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:AARON
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 SE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6402
Mailing Address - Country:US
Mailing Address - Phone:503-360-3068
Mailing Address - Fax:
Practice Address - Street 1:8050 SE 13TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6694
Practice Address - Country:US
Practice Address - Phone:503-360-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
ORAC189187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty