Provider Demographics
NPI:1578263414
Name:3 DRAGONS ACUPUNCTURE AND HERBS
Entity Type:Organization
Organization Name:3 DRAGONS ACUPUNCTURE AND HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHINESE MEDICINE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSERSMITH-GLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-886-9889
Mailing Address - Street 1:1428 SE 19TH AVE STE G
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4516
Mailing Address - Country:US
Mailing Address - Phone:503-347-1048
Mailing Address - Fax:
Practice Address - Street 1:1428 SE 19TH AVE STE G
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4516
Practice Address - Country:US
Practice Address - Phone:503-347-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty