MEDICARE: ACUPUNCTURE AND WELLNESS HQ LLC

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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1942075833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE AND WELLNESS HQ LLC

Provider Business Mailing Address
First Line	:	1524 SE MALDEN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-6052
Country	:	US
Telephone Number	:	919-800-9663
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 SE MALDEN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-6052
Country	:	US
Telephone Number	:	919-800-9663
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLA THOMAS
Credential	:	LAC
Telephone Number	:	919-800-9663

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	11/20/2023

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Directions to “ACUPUNCTURE AND WELLNESS HQ LLC ” Practice Location

Language	Start Address	Practice Location

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