Healthcare Provider Details

I. General information

NPI: 1003553355
Provider Name (Legal Business Name): ALBANY ACUPUNCTURE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 LYON ST SW
ALBANY OR
97321-2921
US

IV. Provider business mailing address

PO BOX 311
TANGENT OR
97389-0311
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-2171
  • Fax: 541-981-2113
Mailing address:
  • Phone: 541-928-2171
  • Fax: 541-981-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MANDI SCHWENDIMAN
Title or Position: CEO
Credential: DA
Phone: 541-928-2171