Provider Demographics
NPI:1922303270
Name:ADDIE HARBIN ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:ADDIE HARBIN ACUPUNCTURE LLC
Other - Org Name:HARBIN ACUPUNCTURE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARBIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MACOM
Authorized Official - Phone:503-512-8663
Mailing Address - Street 1:703 NE HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5612
Mailing Address - Country:US
Mailing Address - Phone:503-512-8663
Mailing Address - Fax:503-512-8632
Practice Address - Street 1:703 NE HOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5612
Practice Address - Country:US
Practice Address - Phone:503-512-8663
Practice Address - Fax:503-512-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01216171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR139-699-0982OtherNPI NUMBER
OR139-699-0982OtherNPI NUMBER