Provider Demographics
NPI:1659017689
Name:WHITE SALMON ACUPUNCTURE LLP
Entity Type:Organization
Organization Name:WHITE SALMON ACUPUNCTURE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:360-524-2788
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:HUSUM
Mailing Address - State:WA
Mailing Address - Zip Code:98623-0179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 NE TOHOMISH ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672
Practice Address - Country:US
Practice Address - Phone:203-536-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114598141OtherNPI
1659017689OtherNPI TYPE 2
WAAC61132900OtherACUPUNCTURE STATE LICENSE
1083215388OtherNPI
WAAC61153026OtherACUPUNCTURE STATE LICENSE