1700132800 NPI number — MR. SCOTT MERRILL KLEIN L.AC.

Table of content: MR. SCOTT MERRILL KLEIN L.AC. (NPI 1700132800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700132800 NPI number — MR. SCOTT MERRILL KLEIN L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
SCOTT
Provider Middle Name:
MERRILL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.AC.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEIN
Provider Other First Name:
SCOTT
Provider Other Middle Name:
MERRILL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700132800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 SE 105TH AVE APT 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97216-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-828-1778
Provider Business Mailing Address Fax Number:
707-248-5948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SE 105TH AVE APT 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97216-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-828-1778
Provider Business Practice Location Address Fax Number:
707-248-5948
Provider Enumeration Date:
07/26/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC159044 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)