Provider Demographics
NPI:1275947475
Name:LAGNIAPPE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:LAGNIAPPE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:504-451-1666
Mailing Address - Street 1:8040 NE SANDY BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-7100
Mailing Address - Country:US
Mailing Address - Phone:504-451-1666
Mailing Address - Fax:
Practice Address - Street 1:839 NW SACAJAWEA PL
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-4104
Practice Address - Country:US
Practice Address - Phone:504-451-1666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC165105302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization