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General NPI Number Information
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NPI Number | 1669973400
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Entity Type | Organization
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Legal Business Name | ROOT & BRANCH
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 7642 SW CAPITOL HWY
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City | PORTLAND
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State | OR
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Zip | 97219-2437
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Country | US
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Telephone | 504-451-1739
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Fax | 503-486-7068
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Provider Business Mailing Address
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Address Line | 6506 SE 89TH AVE
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City | PORTLAND
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State | OR
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Zip | 97266-5346
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Country | US
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Telephone | 504-451-1739
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS KERN
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Credential | LAC
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Telephone | 504-451-1739
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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 | AC186554
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License Number State | OR
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