Healthcare Provider Details

I. General information

NPI: 1518804434
Provider Name (Legal Business Name): QUALITY OF LIFE ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 SW SHADY LN STE 306
TIGARD OR
97223-5481
US

IV. Provider business mailing address

15984 NW RYEGRASS ST
PORTLAND OR
97229-9214
US

V. Phone/Fax

Practice location:
  • Phone: 971-220-7312
  • Fax: 971-220-7313
Mailing address:
  • Phone: 971-220-7312
  • Fax: 971-220-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BLAKE UNDERWOOD
Title or Position: DOCTOR OF ACUPUNCTURE
Credential: LAC
Phone: 971-220-7312