Healthcare Provider Details

I. General information

NPI: 1043045388
Provider Name (Legal Business Name): SR CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 SE BELMONT ST STE 5
PORTLAND OR
97215-1676
US

IV. Provider business mailing address

4246 SE BELMONT ST STE 5
PORTLAND OR
97215-1676
US

V. Phone/Fax

Practice location:
  • Phone: 503-445-8114
  • Fax:
Mailing address:
  • Phone: 503-445-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMESON JAMES
Title or Position: OWNER
Credential: DTCM
Phone: 646-623-9057