Provider Demographics
NPI:1932483302
Name:ORENCO ACUPUNCTURE & WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:ORENCO ACUPUNCTURE & WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM, DIPL AC, LAC
Authorized Official - Phone:503-516-5703
Mailing Address - Street 1:6125 NE CORNELL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5412
Mailing Address - Country:US
Mailing Address - Phone:503-516-5703
Mailing Address - Fax:
Practice Address - Street 1:6125 NE CORNELL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5412
Practice Address - Country:US
Practice Address - Phone:503-516-5703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC154147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty