Provider Demographics
NPI:1578851820
Name:MELETHIL ACUPUNCTURE SERVICES LLC
Entity Type:Organization
Organization Name:MELETHIL ACUPUNCTURE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PADMANABHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELETHIL
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:503-682-9319
Mailing Address - Street 1:8755 SW CITIZENS DR STE 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8860
Mailing Address - Country:US
Mailing Address - Phone:503-682-9319
Mailing Address - Fax:
Practice Address - Street 1:8755 SW CITIZENS DR STE 101
Practice Address - Street 2:SUITE 101
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8860
Practice Address - Country:US
Practice Address - Phone:503-682-9319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01079261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center