Provider Demographics
NPI:1144954157
Name:ELLIOT, ANGIE (ND, LAC)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6947 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5203
Mailing Address - Country:US
Mailing Address - Phone:435-655-1505
Mailing Address - Fax:
Practice Address - Street 1:2348 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3022
Practice Address - Country:US
Practice Address - Phone:503-224-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC200523171100000X
OR4333175F00000X
WANT61319940175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturist