Provider Demographics
NPI:1114262284
Name:THREE BRANCHES CLINIC PC
Entity Type:Organization
Organization Name:THREE BRANCHES CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-267-2142
Mailing Address - Street 1:320 CENTRAL AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2272
Mailing Address - Country:US
Mailing Address - Phone:541-267-2142
Mailing Address - Fax:541-267-2073
Practice Address - Street 1:320 CENTRAL AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2272
Practice Address - Country:US
Practice Address - Phone:541-267-2142
Practice Address - Fax:541-267-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00216171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty