Provider Demographics
NPI:1346663978
Name:INTEGRATIVE WELLNESS ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVICK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, RN
Authorized Official - Phone:971-221-5640
Mailing Address - Street 1:5226 NE AINSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2314
Mailing Address - Country:US
Mailing Address - Phone:971-221-5640
Mailing Address - Fax:
Practice Address - Street 1:3016 NE KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6814
Practice Address - Country:US
Practice Address - Phone:971-221-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99381098261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center