Healthcare Provider Details

I. General information

NPI: 1376258103
Provider Name (Legal Business Name): ROGUE VALLEY ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 NE 7TH ST
GRANTS PASS OR
97526-1634
US

IV. Provider business mailing address

845 NE 7TH ST
GRANTS PASS OR
97526-1634
US

V. Phone/Fax

Practice location:
  • Phone: 541-218-8603
  • Fax: 541-295-8235
Mailing address:
  • Phone: 541-218-8603
  • Fax: 541-295-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN R HARRIS
Title or Position: OWNER
Credential: DACM, L.AC.
Phone: 541-218-8603