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General NPI Number Information
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NPI Number | 1043006356
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Entity Type | Organization
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Legal Business Name | CASCADE MIST ACUPUNCTURE LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 3705 SE CESAR CHAVEZ BLVD
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City | PORTLAND
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State | OR
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Zip | 97202-1704
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Country | US
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Telephone | 971-998-3505
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Fax |
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Provider Business Mailing Address
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Address Line | 4116 SE OAK ST
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City | PORTLAND
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State | OR
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Zip | 97214-2032
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Country | US
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Telephone | 971-998-3505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT DAVID MIST
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Credential | PHD, LAC
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Telephone | 971-998-3505
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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 |
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License Number State |
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