Provider Demographics
NPI:1053705285
Name:LEE HULLENDER RUBIN, DAOM, LAC
Entity type:Organization
Organization Name:LEE HULLENDER RUBIN, DAOM, LAC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HULLENDER RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:503-249-4868
Mailing Address - Street 1:1304 NE ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4428
Mailing Address - Country:US
Mailing Address - Phone:503-249-4868
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS ST
Practice Address - Street 2:STE 205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3443
Practice Address - Country:US
Practice Address - Phone:503-277-4050
Practice Address - Fax:503-477-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty