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General NPI Number Information
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NPI Number | 1881103356
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Entity Type | Organization
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Legal Business Name | CORVALLIS ACUPUNCTURE AND WELLNESS CENTER
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 107 SW 2ND ST
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City | CORVALLIS
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State | OR
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Zip | 97333-4715
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Country | US
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Telephone | 541-602-8172
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Fax | 518-602-8174
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Provider Business Mailing Address
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Address Line | 107 SW 2ND ST
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City | CORVALLIS
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State | OR
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Zip | 97333-4715
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Country | US
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Telephone | 541-602-8172
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Fax | 518-602-8174
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHERINE BROOKE WILLIS
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Credential | L.AC
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Telephone | 541-602-8172
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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 | OR153659
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License Number State | OR
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