Provider Demographics
NPI:1114512126
Name:KEYSBOE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:KEYSBOE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEYSBOE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSAOM
Authorized Official - Phone:503-341-3308
Mailing Address - Street 1:3617 SE SNOWBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6143
Mailing Address - Country:US
Mailing Address - Phone:503-341-3308
Mailing Address - Fax:
Practice Address - Street 1:258 A ST STE 21
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1947
Practice Address - Country:US
Practice Address - Phone:503-341-3308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service