Provider Demographics
NPI:1609177518
Name:ACUPUNCTURE & NATURAL MEDICINE CLINIC INC.
Entity Type:Organization
Organization Name:ACUPUNCTURE & NATURAL MEDICINE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-436-2255
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:CANNON BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97110-1292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1355 SOUTH HEMLOCK STREET
Practice Address - Street 2:
Practice Address - City:CANNON BEACH
Practice Address - State:OR
Practice Address - Zip Code:97110
Practice Address - Country:US
Practice Address - Phone:503-436-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01225251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare