Provider Demographics
NPI:1679041602
Name:VITAL LIFE ACUPUNCTURE CLINIC, LLC
Entity Type:Organization
Organization Name:VITAL LIFE ACUPUNCTURE CLINIC, LLC
Other - Org Name:LITA BUTTOLPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:DSOM
Authorized Official - Phone:503-358-0739
Mailing Address - Street 1:6322 SE 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7039
Mailing Address - Country:US
Mailing Address - Phone:503-358-0739
Mailing Address - Fax:
Practice Address - Street 1:3007 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4026
Practice Address - Country:US
Practice Address - Phone:503-445-7115
Practice Address - Fax:503-445-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center