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General NPI Number Information
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NPI Number | 1205009644
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Entity Type | Organization
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Legal Business Name | AASA-LISA'S ACUPUNCTURE,LLC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 4850 SW SCHOLLS FERRY RD STE 201
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City | PORTLAND
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State | OR
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Zip | 97225-1669
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Country | US
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Telephone | 503-515-2657
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 SW SCHOLLS FERRY RD SUITE 201
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City | PORTLAND
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State | OR
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Zip | 97225-1669
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Country | US
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Telephone | 503-515-2657
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Fax |
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Authorized Official
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Title or Position | L.AC.
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Name | LISA THORBORG
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Credential |
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Telephone | 503-515-2657
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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 | AC00874
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License Number State | OR
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