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General NPI Number Information
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NPI Number | 1932483302
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Entity Type | Organization
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Legal Business Name | ORENCO ACUPUNCTURE & WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 6125 NE CORNELL RD SUITE 230
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City | HILLSBORO
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State | OR
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Zip | 97124-5412
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Country | US
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Telephone | 503-516-5703
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Fax |
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Provider Business Mailing Address
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Address Line | 6125 NE CORNELL RD SUITE 230
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City | HILLSBORO
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State | OR
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Zip | 97124-5412
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Country | US
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Telephone | 503-516-5703
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | MR. BRIAN E BAKER
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Credential | MACOM, DIPL AC, LAC
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Telephone | 503-516-5703
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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 | AC154147
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License Number State | OR
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