Healthcare Provider Details

I. General information

NPI: 1194671503
Provider Name (Legal Business Name): RIVER VALLEY ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E CEDAR AVE STE A201
LA CENTER WA
98629-5482
US

IV. Provider business mailing address

PO BOX 95
RIDGEFIELD WA
98642-0095
US

V. Phone/Fax

Practice location:
  • Phone: 503-395-4157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISHA HERRMANN
Title or Position: OWNER, ACUPUNCTURIST
Credential:
Phone: 360-798-0969