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NPI Code Detail

MEDICARE: PIVOT HEALTH ACUPUNCTURE

MEDICARE: PIVOT HEALTH ACUPUNCTURE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/CenterAC60351775WA
2171100000XAcupuncturist

General Provider Information

NPI Number : 1184040255
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIVOT HEALTH ACUPUNCTURE
Provider Business Mailing Address
First Line : 8810 SE SUNNYBROOK BLVD STE 100
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-6805
Country : US
Telephone Number : 503-607-2226
Fax Number : 503-659-2276
Provider Business Practice Location Address
First Line : 8810 SE SUNNYBROOK BLVD STE 100
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-6805
Country : US
Telephone Number : 360-882-7373
Fax Number : 503-659-2276
Authorized Official
Title or Position : ACUPUNCTURIST
Name : TYLER NATHANIEL ANDRES
Credential : DAOM, LAC
Telephone Number : 503-607-2226
Provider Enumeration Date : 03/12/2014
Last Update Date : 01/26/2024

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Directions to “PIVOT HEALTH ACUPUNCTURE ” Practice Location

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