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General NPI Number Information
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NPI Number | 1114433802
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Entity Type | Organization
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Legal Business Name | THRIVING ACUPUNCTURE
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1708 NW 25TH AVE APT 6
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City | PORTLAND
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State | OR
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Zip | 97210-2435
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Country | US
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Telephone | 406-407-0766
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Fax | 406-407-0766
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Provider Business Mailing Address
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Address Line | 1708 NW 25TH AVE APT 6
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City | PORTLAND
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State | OR
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Zip | 97210-2435
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Country | US
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Telephone | 406-407-0766
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Fax | 406-407-0766
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | PAUL M STORM
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Credential | MACOM, LAC
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Telephone | 406-407-0766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AC185005
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License Number State | OR
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