Provider Demographics
NPI:1205009644
Name:AASA-LISA'S ACUPUNCTURE,LLC
Entity Type:Organization
Organization Name:AASA-LISA'S ACUPUNCTURE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC.
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORBORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-515-2657
Mailing Address - Street 1:4850 SW SCHOLLS FERRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1669
Mailing Address - Country:US
Mailing Address - Phone:503-515-2657
Mailing Address - Fax:
Practice Address - Street 1:4850 SW SCHOLLS FERRY RD
Practice Address - Street 2:STE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1669
Practice Address - Country:US
Practice Address - Phone:503-515-2657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00874171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty