Provider Demographics
NPI:1043821507
Name:ACE INTEGARTIVE CLINIC, INC
Entity Type:Organization
Organization Name:ACE INTEGARTIVE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SE JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JI
Authorized Official - Suffix:
Authorized Official - Credentials:ND, DC
Authorized Official - Phone:503-490-8250
Mailing Address - Street 1:14455 SW ALLEN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4428
Mailing Address - Country:US
Mailing Address - Phone:503-490-8250
Mailing Address - Fax:
Practice Address - Street 1:14455 SW ALLEN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4428
Practice Address - Country:US
Practice Address - Phone:503-490-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty