Provider Demographics
NPI:1043698756
Name:ACUPUNCTURE & NATURAL MEDICINE CLINIC, LLC
Entity type:Organization
Organization Name:ACUPUNCTURE & NATURAL MEDICINE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:ARIA
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-436-2255
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:CANNON BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97110-1292
Mailing Address - Country:US
Mailing Address - Phone:503-436-2255
Mailing Address - Fax:888-653-7244
Practice Address - Street 1:1355 S HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:CANNON BEACH
Practice Address - State:OR
Practice Address - Zip Code:97110-3055
Practice Address - Country:US
Practice Address - Phone:503-436-2255
Practice Address - Fax:888-653-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC167797171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty