Healthcare Provider Details

I. General information

NPI: 1215328984
Provider Name (Legal Business Name): JULIA WALLS DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD STE B6
TUALATIN OR
97062-8859
US

IV. Provider business mailing address

2031 SE BELMONT ST
PORTLAND OR
97214-2812
US

V. Phone/Fax

Practice location:
  • Phone: 503-489-8480
  • Fax: 503-922-3048
Mailing address:
  • Phone: 503-489-8480
  • Fax: 503-922-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC167655
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: