Provider Demographics
NPI:1861681215
Name:BROWN, SHANNON KENT (ND, MSOM, LAC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KENT
Last Name:BROWN
Suffix:
Gender:M
Credentials:ND, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 SE WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1668
Mailing Address - Country:US
Mailing Address - Phone:503-453-3662
Mailing Address - Fax:
Practice Address - Street 1:4011 SE WOODWARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1668
Practice Address - Country:US
Practice Address - Phone:503-453-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01122171100000X
OR1113175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist