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General NPI Number Information
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NPI Number | 1427598135
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Entity Type | Organization
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Legal Business Name | NORTHWEST FAMILY ACUPUNCTURE
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 1622 NW 15TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-2572
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Country | US
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Telephone | 503-548-7170
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Fax |
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Provider Business Mailing Address
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Address Line | 10701 NW COPELAND ST
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City | PORTLAND
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State | OR
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Zip | 97229-6141
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA HICKS
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Credential | LAC
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Telephone | 503-548-7170
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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 | 180003
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License Number State | OR
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