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General NPI Number Information
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NPI Number | 1063395044
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Entity Type | Organization
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Legal Business Name | IRIS ACUPUNCTURE CLINIC LLC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 129 NE 102ND AVE STE A
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City | PORTLAND
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State | OR
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Zip | 97220-4102
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Country | US
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Telephone | 503-837-6655
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Fax | 866-539-5513
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Provider Business Mailing Address
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Address Line | 11954 NE GLISAN ST # 327
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City | PORTLAND
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State | OR
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Zip | 97220-2143
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Country | US
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Telephone | 503-837-6655
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Fax | 866-539-5513
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Authorized Official
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Title or Position | OWNER, LICENSED ACUPUNCTURIST
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Name | SALLIE A MCKIBBEN
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Credential | LAC
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Telephone | 503-837-6655
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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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