Provider Demographics
NPI:1144553215
Name:BEHALL, DIANE L (LAC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:BEHALL
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 1:5714 NE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4957
Mailing Address - Country:US
Mailing Address - Phone:503-208-4325
Mailing Address - Fax:
Practice Address - Street 1:555 SW OAK ST
Practice Address - Street 2:WESTSIDE ATHLETIC CLUB
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1752
Practice Address - Country:US
Practice Address - Phone:503-208-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist