Provider Demographics
NPI:1861841504
Name:SOARING CRANE ACUOUNCTURE LLC
Entity Type:Organization
Organization Name:SOARING CRANE ACUOUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMARKAUR
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHUP
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-303-7595
Mailing Address - Street 1:630 B AVE. #3
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034
Mailing Address - Country:US
Mailing Address - Phone:503-303-7595
Mailing Address - Fax:503-303-7595
Practice Address - Street 1:630 B AVE. #3
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034
Practice Address - Country:US
Practice Address - Phone:503-303-7595
Practice Address - Fax:503-303-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty