Provider Demographics
NPI:1386009348
Name:VIBRANT LIFE ACUPUNCTURE
Entity Type:Organization
Organization Name:VIBRANT LIFE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-515-7702
Mailing Address - Street 1:15962 BOONES FERRY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4351
Mailing Address - Country:US
Mailing Address - Phone:503-515-7702
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4351
Practice Address - Country:US
Practice Address - Phone:503-515-7702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC159474171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty