Provider Demographics
NPI:1003247479
Name:LIFE BALANCE ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:LIFE BALANCE ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MANUELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERLINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-881-8996
Mailing Address - Street 1:189 LIBERTY ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3682
Mailing Address - Country:US
Mailing Address - Phone:503-881-8996
Mailing Address - Fax:
Practice Address - Street 1:189 LIBERTY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3682
Practice Address - Country:US
Practice Address - Phone:503-881-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC165229261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center