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General NPI Number Information
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NPI Number | 1700200235
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Entity Type | Organization
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Legal Business Name | JULIE KOROCH ACUPUNCTURE LLC
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 7925 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97215-2341
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Country | US
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Telephone | 503-701-3042
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 NE 72ND AVE
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City | PORTLAND
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State | OR
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Zip | 97213-5707
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Country | US
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Telephone | 503-701-3042
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | JULIE HAWKINS KOROCH
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Credential | L.AC.
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Telephone | 503-701-3042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 161400
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License Number State | OR
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