Provider Demographics
NPI:1932599263
Name:MCANINCH, LAUREN (LMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MCANINCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 SE CLAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3151
Mailing Address - Country:US
Mailing Address - Phone:971-230-4705
Mailing Address - Fax:
Practice Address - Street 1:4424 SE CLAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3151
Practice Address - Country:US
Practice Address - Phone:971-230-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR145957172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist