Provider Demographics
NPI:1295220291
Name:BLUE TURTLE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:BLUE TURTLE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGENIA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-991-8950
Mailing Address - Street 1:4838 N PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4461
Mailing Address - Country:US
Mailing Address - Phone:503-991-8950
Mailing Address - Fax:888-972-7503
Practice Address - Street 1:2738 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1723
Practice Address - Country:US
Practice Address - Phone:503-991-8950
Practice Address - Fax:888-972-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00674261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center