Provider Demographics
NPI:1174755664
Name:MARX, BENJAMIN LEO (LAC)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LEO
Last Name:MARX
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S STATE ST
Mailing Address - Street 2:SUITE W
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3932
Mailing Address - Country:US
Mailing Address - Phone:503-863-0466
Mailing Address - Fax:
Practice Address - Street 1:4424 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2331
Practice Address - Country:US
Practice Address - Phone:503-928-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist