Provider Demographics
NPI:1306019310
Name:INNER GATE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:INNER GATE ACUPUNCTURE LLC
Other - Org Name:INNER GATE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAACMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-284-6996
Mailing Address - Street 1:1421 SE ANKENY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1471
Mailing Address - Country:US
Mailing Address - Phone:503-284-6996
Mailing Address - Fax:503-459-4253
Practice Address - Street 1:1421 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1471
Practice Address - Country:US
Practice Address - Phone:503-284-6996
Practice Address - Fax:503-459-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty