MEDICARE: TJ ACUPUNCTURE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00654	OR

General Provider Information

NPI Number	:	1528477155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TJ ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	5677 BONITA RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3217
Country	:	US
Telephone Number	:	503-475-9657
Fax Number	:

Provider Business Practice Location Address
First Line	:	7110 SW FIR LOOP
Second Line	:	SUITE 205
City	:	TIGARD
State	:	OR
Zip	:	97223-8084
Country	:	US
Telephone Number	:	503-475-9657
Fax Number	:

Authorized Official
Title or Position	:	LAC.
Name	:	TAIPING JIA
Credential	:	OMD
Telephone Number	:	503-475-9657

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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Directions to “TJ ACUPUNCTURE LLC ” Practice Location

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