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General NPI Number Information
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NPI Number | 1104099654
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Entity Type | Organization
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Legal Business Name | PENINSULA FAMILY ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 7617 N DECATUR ST
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City | PORTLAND
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State | OR
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Zip | 97203-5009
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Country | US
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Telephone | 503-283-5518
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Fax | 503-808-9120
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Provider Business Mailing Address
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Address Line | 7617 N DECATUR ST
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City | PORTLAND
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State | OR
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Zip | 97203-5009
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Country | US
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Telephone | 503-283-5518
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Fax | 503-808-9120
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONNA M. STEWART
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Credential | L.AC., PT
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Telephone | 503-283-5518
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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 | AC00710
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License Number State | OR
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