Provider Demographics
NPI:1346600582
Name:CLEAR HEART ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:CLEAR HEART ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUCUM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-395-5228
Mailing Address - Street 1:PO BOX 86371
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97286-0371
Mailing Address - Country:US
Mailing Address - Phone:503-395-5228
Mailing Address - Fax:844-814-4767
Practice Address - Street 1:4605 NE FREMONT ST STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1708
Practice Address - Country:US
Practice Address - Phone:503-395-5228
Practice Address - Fax:844-814-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC175542171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty