Provider Demographics
NPI:1346546272
Name:BENEVOLENCE HEALING ARTS LLC
Entity Type:Organization
Organization Name:BENEVOLENCE HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:WILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-593-5319
Mailing Address - Street 1:1221 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3890
Mailing Address - Country:US
Mailing Address - Phone:503-445-7767
Mailing Address - Fax:503-459-4221
Practice Address - Street 1:1221 SE MADISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3890
Practice Address - Country:US
Practice Address - Phone:503-445-7767
Practice Address - Fax:503-459-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153864171100000X
ORAC150650171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty