Provider Demographics
NPI:1336665108
Name:STONEBURNER ACUPUNCTURE
Entity Type:Organization
Organization Name:STONEBURNER ACUPUNCTURE
Other - Org Name:STONEBURNER ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONEBURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-784-1660
Mailing Address - Street 1:1135 SE SALMON ST STE 211
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3375
Mailing Address - Country:US
Mailing Address - Phone:503-784-1660
Mailing Address - Fax:
Practice Address - Street 1:1135 SE SALMON ST STE 211
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3375
Practice Address - Country:US
Practice Address - Phone:503-784-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC155999171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670041Medicaid