Provider Demographics
NPI:1699031872
Name:MIA NEUSE, L.AC., LLC
Entity Type:Organization
Organization Name:MIA NEUSE, L.AC., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-539-9180
Mailing Address - Street 1:7925 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2341
Mailing Address - Country:US
Mailing Address - Phone:503-467-4127
Mailing Address - Fax:503-459-4183
Practice Address - Street 1:7925 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2341
Practice Address - Country:US
Practice Address - Phone:503-467-4127
Practice Address - Fax:503-459-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty