Healthcare Provider Details

I. General information

NPI: 1902591357
Provider Name (Legal Business Name): DANCING ASPEN HEALING ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22400 SE STARK ST STE 106
GRESHAM OR
97030-2656
US

IV. Provider business mailing address

333 NW WALLULA AVE
GRESHAM OR
97030-5410
US

V. Phone/Fax

Practice location:
  • Phone: 503-913-2136
  • Fax: 503-825-0137
Mailing address:
  • Phone: 503-913-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CAITLYNN CLAIRE DIDLICK BOHMAN
Title or Position: BUSINESS OWNER / ACUPUNCTURIST
Credential: DACM, MACOM, LAC
Phone: 503-913-2136