Provider Demographics
NPI:1942075833
Name:ACUPUNCTURE AND WELLNESS HQ LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE AND WELLNESS HQ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:919-800-9663
Mailing Address - Street 1:1524 SE MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6052
Mailing Address - Country:US
Mailing Address - Phone:919-800-9663
Mailing Address - Fax:
Practice Address - Street 1:1524 SE MALDEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6052
Practice Address - Country:US
Practice Address - Phone:919-800-9663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center