Provider Demographics
NPI:1144680745
Name:WHALEN ACUPUNCTURE AND WELLNESS, LLC
Entity type:Organization
Organization Name:WHALEN ACUPUNCTURE AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:208-791-9136
Mailing Address - Street 1:14825 SE HARMON CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1722
Mailing Address - Country:US
Mailing Address - Phone:208-791-9136
Mailing Address - Fax:
Practice Address - Street 1:10915 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3348
Practice Address - Country:US
Practice Address - Phone:503-261-1120
Practice Address - Fax:503-261-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC176130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty