Provider Demographics
NPI:1730658956
Name:LAIRD, CHRISTOPHER ERIK
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ERIK
Last Name:LAIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2439
Mailing Address - Country:US
Mailing Address - Phone:503-479-7179
Mailing Address - Fax:503-676-3176
Practice Address - Street 1:4434 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2439
Practice Address - Country:US
Practice Address - Phone:503-479-7179
Practice Address - Fax:503-676-3176
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2312253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care