Provider Demographics
NPI:1700200235
Name:JULIE KOROCH ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:JULIE KOROCH ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:KOROCH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-701-3042
Mailing Address - Street 1:3725 NE 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5707
Mailing Address - Country:US
Mailing Address - Phone:503-701-3042
Mailing Address - Fax:
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:503-701-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR161400261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service