Provider Demographics
NPI:1790227890
Name:STONE FOREST ACUPUNCTURE
Entity Type:Organization
Organization Name:STONE FOREST ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYBELE
Authorized Official - Middle Name:WHITNEY
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:206-683-7789
Mailing Address - Street 1:5922 NE 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4208
Mailing Address - Country:US
Mailing Address - Phone:206-683-7789
Mailing Address - Fax:
Practice Address - Street 1:1616 SE BYBEE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5715
Practice Address - Country:US
Practice Address - Phone:503-236-4654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC177817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty