Provider Demographics
NPI:1265145627
Name:KRISANDA, CHELSEA (LAC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:KRISANDA
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 1:8609 SE MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1430
Mailing Address - Country:US
Mailing Address - Phone:585-474-2339
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY ST STE 225
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1544
Practice Address - Country:US
Practice Address - Phone:503-719-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC213983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist