Provider Demographics
NPI:1184040255
Name:PIVOT HEALTH ACUPUNCTURE
Entity Type:Organization
Organization Name:PIVOT HEALTH ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:503-607-2226
Mailing Address - Street 1:8810 SE SUNNYBROOK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6805
Mailing Address - Country:US
Mailing Address - Phone:503-607-2226
Mailing Address - Fax:503-659-2276
Practice Address - Street 1:8810 SE SUNNYBROOK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6805
Practice Address - Country:US
Practice Address - Phone:360-882-7373
Practice Address - Fax:503-659-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
WAAC60351775261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty