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General NPI Number Information
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NPI Number | 1689046096
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Entity Type | Organization
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Legal Business Name | FAMILY ACUPUNCTURE & HERBAL MEDICINE
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Dates
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Enumeration Date | 10/24/2015
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Last Update Date | 10/24/2015
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Provider Practice Location Address
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Address Line | 506 CASCADE AVE STE 100
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City | HOOD RIVER
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State | OR
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Zip | 97031-2088
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Country | US
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Telephone | 541-645-0708
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Fax |
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Provider Business Mailing Address
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Address Line | 503 PROSPECT AVE
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City | HOOD RIVER
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State | OR
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Zip | 97031-2163
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Country | US
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Telephone | 541-645-0708
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST AND HERBALIST
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Name | LAURA MAYO
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Credential | LAC
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Telephone | 541-645-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC157487
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License Number State | OR
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