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General NPI Number Information
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NPI Number | 1699196311
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Entity Type | Organization
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Legal Business Name | THE VITAL COMPASS
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 5412 N WILLIAMS AVE
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City | PORTLAND
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State | OR
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Zip | 97217-2740
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Country | US
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Telephone | 971-373-8378
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Fax |
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Provider Business Mailing Address
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Address Line | 5412 N WILLIAMS AVE
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City | PORTLAND
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State | OR
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Zip | 97217-2740
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Country | US
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Telephone | 971-373-8378
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Fax |
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Authorized Official
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Title or Position | WORKER-OWNER, CO-FOUNDER
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Name | KIM WAYLAND LLEWELLIN
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Credential | L.AC
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Telephone | 971-373-8378
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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 | AC150088
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC150271
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License Number State | OR
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