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General NPI Number Information
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NPI Number | 1689129744
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Entity Type | Organization
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Legal Business Name | STUDIO CLINIC ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 819 SE MORRISON ST STE 140
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City | PORTLAND
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State | OR
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Zip | 97214-6309
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Country | US
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Telephone | 877-578-7806
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Fax |
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Provider Business Mailing Address
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Address Line | 819 SE MORRISON ST STE 140
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City | PORTLAND
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State | OR
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Zip | 97214-6309
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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 | FOUNDER AND DIRECTOR
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Name | ALFRED DONICH
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Credential |
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Telephone | 877-578-7806
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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 | AC174157
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License Number State | OR
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