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General NPI Number Information
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NPI Number | 1003276163
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Entity Type | Organization
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Legal Business Name | VALLEY OF PEACE NATURAL HEALTH CENTER, LLC
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 1617 4TH ST
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City | LA GRANDE
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State | OR
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Zip | 97850-2505
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Country | US
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Telephone | 541-910-2046
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Fax | 888-264-5835
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Provider Business Mailing Address
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Address Line | 1610 Z AVE PO BOX 1164
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City | LA GRANDE
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State | OR
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Zip | 97850-3745
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Country | US
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Telephone | 541-910-2046
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Fax | 888-264-5835
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | JENNIFER A MOORE
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Credential | L.AC
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Telephone | 541-910-2046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01183
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License Number State | OR
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