Provider Demographics
NPI:1962662411
Name:SPIRIT GATE ACUPUNCTURE, PC
Entity Type:Organization
Organization Name:SPIRIT GATE ACUPUNCTURE, PC
Other - Org Name:KATHERINE DELLENEY, M.S.O.M., L.AC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELLENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSOM, LAC
Authorized Official - Phone:971-998-7064
Mailing Address - Street 1:4505 SE BOISE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4037
Mailing Address - Country:US
Mailing Address - Phone:971-998-7064
Mailing Address - Fax:
Practice Address - Street 1:309 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-2313
Practice Address - Country:US
Practice Address - Phone:503-842-6532
Practice Address - Fax:503-842-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00812171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty