Provider Demographics
NPI:1609589134
Name:MOLLY ERICKSON ACUPUNCTURE LLC
Entity type:Organization
Organization Name:MOLLY ERICKSON ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-232-6896
Mailing Address - Street 1:1724 NW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2463
Mailing Address - Country:US
Mailing Address - Phone:612-232-6896
Mailing Address - Fax:
Practice Address - Street 1:2455 NW MARSHALL ST STE 7B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2949
Practice Address - Country:US
Practice Address - Phone:612-232-6896
Practice Address - Fax:503-436-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty