Provider Demographics
NPI:1518521038
Name:TCM ACUPUNCTURE AND MASSAGE CLINIC
Entity Type:Organization
Organization Name:TCM ACUPUNCTURE AND MASSAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-347-4286
Mailing Address - Street 1:18840 SW BOONES FERRY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9594
Mailing Address - Country:US
Mailing Address - Phone:503-941-5351
Mailing Address - Fax:503-610-6980
Practice Address - Street 1:18840 SW BOONES FERRY RD STE 110
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9594
Practice Address - Country:US
Practice Address - Phone:503-941-5351
Practice Address - Fax:503-610-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1215403472OtherNPI