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General NPI Number Information
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NPI Number | 1962192658
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Entity Type | Organization
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Legal Business Name | MT ROSE ACUPUNCTURE LLC
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 333 NE RUSSELL ST STE 209
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City | PORTLAND
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State | OR
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Zip | 97212-3762
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Country | US
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Telephone | 530-894-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 5856 NE 24TH AVE
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City | PORTLAND
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State | OR
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Zip | 97211-6126
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Country | US
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Telephone | 415-860-9211
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ERIC ROSENBERG
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Credential | L.AC.
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Telephone | 530-894-6420
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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 |
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License Number State |
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