Provider Demographics
NPI:1003387390
Name:DANIEL RAIDER, ACUPUNCTURIST LLC
Entity Type:Organization
Organization Name:DANIEL RAIDER, ACUPUNCTURIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM, LAC
Authorized Official - Phone:503-314-1878
Mailing Address - Street 1:2330 NW FLANDERS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3400
Mailing Address - Country:US
Mailing Address - Phone:503-314-1878
Mailing Address - Fax:
Practice Address - Street 1:2330 NW FLANDERS ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3400
Practice Address - Country:US
Practice Address - Phone:503-314-1878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL RAIDER, ACUPUNCTURIST LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty