Active NPI
Rebecca L Provorse, ND, LAC
- Acupuncturist
- Portland, OR
National Provider Identifier
1508076258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC00861
- Practice address
- 1435 NW 23Rd Ave
Suite 102
Portland, OR 97210-2642 - Phone
- (503) 222-1865
- Fax
- (866) 842-8747
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC00861 | OR | Primary |
| Naturopath | 175F00000X | 1375 | OR |
Addresses
Primary practice location
1435 NW 23Rd Ave
Suite 102
Portland, OR 97210-2642
Mailing address
1435 NW 23Rd Ave
Suite 102
Portland, OR 97210-2642
Phone (503) 222-1865
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC00861 | OR | MD | Acupuncturist |
| 1375 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1508076258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1435 NW 23RD AVE",
"address_2": "SUITE 102",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102642",
"telephone_number": "503-222-1865",
"fax_number": "866-842-8747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1435 NW 23RD AVE",
"address_2": "SUITE 102",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102642",
"telephone_number": "503-222-1865",
"fax_number": "866-842-8747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVORSE",
"first_name": "REBECCA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "ND, LAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-23",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "OR",
"license": "AC00861",
"primary": true
},
{
"code": "175F00000X",
"taxonomy_group": "",
"desc": "Naturopath",
"state": "OR",
"license": "1375",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
- Providence St Vincent Hospital
- Providence St Vincent Medical Center
- Providence St Vincent Medical Center
- Providence St Vincent Medical Center
- Providence St. Vincent Medical Center
- Jean-Claude Kleber Provost, FNP-C
- Ralph Merrill Prows, M.D.
- Jonathan R Prue, LMT
- Amy Kathleen Pruett, DMD
- David Rollins Pruett, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.