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General NPI Number Information
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NPI Number | 1669810875
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Entity Type | Organization
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Legal Business Name | EAST VANCOUVER ACUPUNCTURE, PLLC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 16505 SE 1ST ST STE H
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City | VANCOUVER
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State | WA
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Zip | 98684-9586
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Country | US
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Telephone | 360-326-8306
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Fax | 360-433-0748
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Provider Business Mailing Address
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Address Line | 7210 NE 217TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-9063
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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 | BRIAN KLUMP
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Credential | EAMP
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Telephone | 360-326-8306
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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 | AC60248808
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License Number State | WA
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