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General NPI Number Information
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NPI Number | 1104375500
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Entity Type | Organization
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Legal Business Name | BODY MECHANIX ACUPUNCTURE/MASSAGE
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 9355 SW DAVIES RD
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City | BEAVERTON
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State | OR
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Zip | 97008-6766
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Country | US
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Telephone | 509-939-6924
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Fax |
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Provider Business Mailing Address
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Address Line | 9355 SW DAVIES RD
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City | BEAVERTON
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State | OR
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Zip | 97008-6766
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Country | US
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Telephone | 509-939-6924
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | KATLYN MARQUESS
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Credential | LAC
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Telephone | 509-939-6924
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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 | AC174642
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License Number State | OR
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