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General NPI Number Information
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NPI Number | 1760668651
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH CENTER, INC.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 1417 SE 34TH AVE
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City | PORTLAND
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State | OR
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Zip | 97214-4225
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Country | US
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Telephone | 503-481-0283
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Fax | 503-536-6590
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Provider Business Mailing Address
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Address Line | 1417 SE 34TH AVE
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City | PORTLAND
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State | OR
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Zip | 97214-4225
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Country | US
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Telephone | 503-481-0283
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Fax | 503-536-6590
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ALFRED THIEME III
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Credential | L.AC., DIPL. AC.
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Telephone | 503-481-0283
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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 | AC01143
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License Number State | OR
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