Provider Demographics
NPI:1760874622
Name:NORTHWEST ACUPUNCTURE CENTER
Entity Type:Organization
Organization Name:NORTHWEST ACUPUNCTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-381-2600
Mailing Address - Street 1:11565 SW HALL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8493
Mailing Address - Country:US
Mailing Address - Phone:503-381-2600
Mailing Address - Fax:
Practice Address - Street 1:11565 SW HALL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8493
Practice Address - Country:US
Practice Address - Phone:503-381-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC161758305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization