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General NPI Number Information
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NPI Number | 1679084396
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Entity Type | Organization
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Legal Business Name | SOUTHERN WIND ACUPUNCTURE
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 4115 N MISSISSIPPI AVE
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City | PORTLAND
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State | OR
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Zip | 97217-3130
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Country | US
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Telephone | 858-354-5039
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Fax |
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Provider Business Mailing Address
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Address Line | 4115 N MISSISSIPPI AVE
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City | PORTLAND
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State | OR
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Zip | 97217-3130
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Country | US
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Telephone | 858-354-5039
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | LAUREN PARISH
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Credential | LAC
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Telephone | 858-354-5039
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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 | AC182001
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License Number State | OR
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