Provider Demographics
NPI:1922361807
Name:BOUNCE BACK ACUPUNCTURE
Entity Type:Organization
Organization Name:BOUNCE BACK ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALOGH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-515-4457
Mailing Address - Street 1:6225 SW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4461
Mailing Address - Country:US
Mailing Address - Phone:503-515-4457
Mailing Address - Fax:503-419-6065
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 240
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8116
Practice Address - Country:US
Practice Address - Phone:503-515-4457
Practice Address - Fax:503-419-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156571261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center