Provider Demographics
NPI:1841464187
Name:JOHN C. SLOSBERG L.A.C., PC
Entity type:Organization
Organization Name:JOHN C. SLOSBERG L.A.C., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SLOSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-731-8878
Mailing Address - Street 1:3272 NE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3243
Mailing Address - Country:US
Mailing Address - Phone:503-731-8878
Mailing Address - Fax:503-331-0164
Practice Address - Street 1:2143 NE BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1512
Practice Address - Country:US
Practice Address - Phone:503-320-1342
Practice Address - Fax:503-331-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty