Provider Demographics
NPI:1528406683
Name:BODY & MIND ACUPUNCTURE
Entity Type:Organization
Organization Name:BODY & MIND ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:503-886-9238
Mailing Address - Street 1:11825 SW GREENBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6466
Mailing Address - Country:US
Mailing Address - Phone:503-886-9238
Mailing Address - Fax:866-818-1133
Practice Address - Street 1:11825 SW GREENBURG RD STE 110
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6466
Practice Address - Country:US
Practice Address - Phone:503-886-9238
Practice Address - Fax:866-818-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01056171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty