Healthcare Provider Details

I. General information

NPI: 1477212488
Provider Name (Legal Business Name): ADVANCED ACUPUNCTURE INC2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 03/04/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17040 PILKINGTON RD STE 211
LAKE OSWEGO OR
97035-5587
US

IV. Provider business mailing address

17040 PILKINGTON RD STE 211
LAKE OSWEGO OR
97035-5587
US

V. Phone/Fax

Practice location:
  • Phone: 503-908-0157
  • Fax: 503-908-0187
Mailing address:
  • Phone: 503-908-0157
  • Fax: 503-908-0187

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: NOOSHIN NIKKI MEDGHALCHY
Title or Position: OWNER/PROVIDER
Credential: DAOM
Phone: 503-908-0157