Provider Demographics
NPI:1720744998
Name:MARI GREENLY, LAC, LLC
Entity Type:Organization
Organization Name:MARI GREENLY, LAC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-349-8122
Mailing Address - Street 1:2311 E BURNSIDE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1880
Mailing Address - Country:US
Mailing Address - Phone:503-349-8122
Mailing Address - Fax:971-319-2195
Practice Address - Street 1:2311 E BURNSIDE ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1880
Practice Address - Country:US
Practice Address - Phone:503-349-8122
Practice Address - Fax:971-319-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty