Provider Demographics
NPI:1992020788
Name:EAST MEETS WEST ACUPUNCTURE AND MASSAGE, LLC
Entity Type:Organization
Organization Name:EAST MEETS WEST ACUPUNCTURE AND MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM, LAC, LMT
Authorized Official - Phone:503-261-1120
Mailing Address - Street 1:10915 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3348
Mailing Address - Country:US
Mailing Address - Phone:503-261-1120
Mailing Address - Fax:
Practice Address - Street 1:10915 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3348
Practice Address - Country:US
Practice Address - Phone:503-261-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150417171100000X
OR12447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty