Healthcare Provider Details

I. General information

NPI: 1437063054
Provider Name (Legal Business Name): LITTLE ROSE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81604 FAIRGROUNDS RD
TYGH VALLEY OR
97063-9659
US

IV. Provider business mailing address

81604 FAIRGROUNDS RD
TYGH VALLEY OR
97063-9659
US

V. Phone/Fax

Practice location:
  • Phone: 541-993-1204
  • Fax:
Mailing address:
  • Phone: 541-993-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARA HOUCK
Title or Position: OWNER/REGISTERED AGENT
Credential: LAC
Phone: 541-993-1204