Provider Demographics
NPI:1801001409
Name:ACUPUNCTURE AT RIVERSIDE
Entity Type:Organization
Organization Name:ACUPUNCTURE AT RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-474-1974
Mailing Address - Street 1:957 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3103
Mailing Address - Country:US
Mailing Address - Phone:541-474-1974
Mailing Address - Fax:541-474-1975
Practice Address - Street 1:957 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3103
Practice Address - Country:US
Practice Address - Phone:541-474-1974
Practice Address - Fax:541-474-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00799171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty