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General NPI Number Information
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NPI Number | 1841624194
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Entity Type | Organization
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Legal Business Name | KRISHNA AVALON ACUPUNCTURE, INC
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 4605 NE FREMONT ST STE 103
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City | PORTLAND
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State | OR
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Zip | 97213
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Country | US
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Telephone | 503-522-2872
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Fax | 844-252-8069
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Provider Business Mailing Address
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Address Line | 4816 NE GOING ST.
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City | PORTLAND
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State | OR
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Zip | 97218
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Country | US
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Telephone | 503-522-2872
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Fax | 844-252-8069
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Authorized Official
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Title or Position | OWNER
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Name | KRISHNA AVALON
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Credential | L.AC
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Telephone | 503-522-2872
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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 | AC01299
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License Number State | OR
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