Healthcare Provider Details

I. General information

NPI: 1457621039
Provider Name (Legal Business Name): HEALING PATH ACUPUNCTURE & HERBAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SE WASHINGTON ST STE 109
MILWAUKIE OR
97222-7647
US

IV. Provider business mailing address

2305 SE WASHINGTON ST STE 109
MILWAUKIE OR
97222-7647
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-0064
  • Fax:
Mailing address:
  • Phone: 503-659-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00709
License Number StateOR

VIII. Authorized Official

Name: DR. JOYCE ELAINE SHIELDS
Title or Position: OWNER
Credential: DAOM
Phone: 503-659-0064