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General NPI Number Information
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NPI Number | 1013305184
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Entity Type | Organization
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Legal Business Name | LAURA GOFF ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 12/24/2014
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Last Update Date | 12/24/2014
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Provider Practice Location Address
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Address Line | 7048 SE MILWAUKIE AVE
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City | PORTLAND
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State | OR
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Zip | 97202-5719
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Country | US
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Telephone | 503-730-7749
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Fax |
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Provider Business Mailing Address
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Address Line | 1744 SE NEHALEM ST
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City | PORTLAND
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State | OR
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Zip | 97202-6734
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Country | US
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Telephone | 503-730-7749
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | MRS. LAURA AMROFELL GOFF
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Credential | L.AC.
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Telephone | 503-730-7749
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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 | AC01241
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License Number State | OR
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