Provider Demographics
NPI:1619113487
Name:BRIDGE POINT LLC
Entity Type:Organization
Organization Name:BRIDGE POINT LLC
Other - Org Name:BRIDGE POINT ACUPUNCTURE & HERBAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUVENDACK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-504-9819
Mailing Address - Street 1:10350 N VANCOUVER WAY # 235
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7530
Mailing Address - Country:US
Mailing Address - Phone:503-504-9819
Mailing Address - Fax:
Practice Address - Street 1:12778 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1539
Practice Address - Country:US
Practice Address - Phone:503-504-9819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1174774848OtherNPPES