Provider Demographics
NPI:1114433802
Name:THRIVING ACUPUNCTURE
Entity Type:Organization
Organization Name:THRIVING ACUPUNCTURE
Other - Org Name:PAUL STORM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM, LAC
Authorized Official - Phone:406-407-0766
Mailing Address - Street 1:1708 NW 25TH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2435
Mailing Address - Country:US
Mailing Address - Phone:406-407-0766
Mailing Address - Fax:406-407-0766
Practice Address - Street 1:1708 NW 25TH AVE APT 6
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2435
Practice Address - Country:US
Practice Address - Phone:406-407-0766
Practice Address - Fax:406-407-0766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL STORM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC185005261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========Medicaid