Provider Demographics
NPI:1881960862
Name:RICK DETROYE. L.AC., LLC
Entity type:Organization
Organization Name:RICK DETROYE. L.AC., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DETROYE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-484-3513
Mailing Address - Street 1:200 NE 20TH AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3094
Mailing Address - Country:US
Mailing Address - Phone:503-484-3513
Mailing Address - Fax:503-239-1167
Practice Address - Street 1:200 NE 20TH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3094
Practice Address - Country:US
Practice Address - Phone:503-484-3513
Practice Address - Fax:503-239-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00389171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty