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General NPI Number Information
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NPI Number | 1922361807
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Entity Type | Organization
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Legal Business Name | BOUNCE BACK ACUPUNCTURE
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Dates
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Enumeration Date | 06/16/2012
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Last Update Date | 06/16/2012
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Provider Practice Location Address
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Address Line | 15455 NW GREENBRIER PKWY STE 240
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City | BEAVERTON
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State | OR
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Zip | 97006-8116
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Country | US
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Telephone | 503-515-4457
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Fax | 503-419-6065
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Provider Business Mailing Address
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Address Line | 6225 SW WILSON AVE
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City | BEAVERTON
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State | OR
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Zip | 97008-4461
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Country | US
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Telephone | 503-515-4457
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Fax | 503-419-6065
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MR. MICHAEL S. BALOGH
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Credential | L.AC.
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Telephone | 503-515-4457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC156571
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License Number State | OR
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