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General NPI Number Information
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NPI Number | 1992020788
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Entity Type | Organization
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Legal Business Name | EAST MEETS WEST ACUPUNCTURE AND MASSAGE, LLC
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 10915 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97216-3348
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Country | US
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Telephone | 503-261-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 10915 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97216-3348
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Country | US
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Telephone | 503-261-1120
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Fax |
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Authorized Official
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Title or Position | CEO,
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Name | MRS. WANDA ELIZABETH NORMAN
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Credential | MACOM, LAC, LMT
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Telephone | 503-261-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 12447
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC150417
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License Number State | OR
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