Healthcare Provider Details

I. General information

NPI: 1043821507
Provider Name (Legal Business Name): ACE INTEGARTIVE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14455 SW ALLEN BLVD STE 101
BEAVERTON OR
97005-4428
US

IV. Provider business mailing address

14455 SW ALLEN BLVD STE 101
BEAVERTON OR
97005-4428
US

V. Phone/Fax

Practice location:
  • Phone: 503-490-8250
  • Fax:
Mailing address:
  • Phone: 503-490-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. SE JUN JI
Title or Position: CLINIC DIRECTOR
Credential: ND, DC
Phone: 503-490-8250