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General NPI Number Information
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NPI Number | 1598001745
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Entity Type | Organization
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Legal Business Name | MILL-E-MOTO
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 4625 SW WASHINGTON AVE
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City | BEAVERTON
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State | OR
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Zip | 97005-0529
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Country | US
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Telephone | 503-758-7108
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Fax |
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Provider Business Mailing Address
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Address Line | 4625 SW WASHINGTON AVE
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City | BEAVERTON
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State | OR
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Zip | 97005-0529
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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 | RYAN JOHN MILLEY
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Credential | MACOM, LAC
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Telephone | 503-758-7108
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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 | AC00981
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License Number State | OR
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