Provider Demographics
NPI:1023680220
Name:FLOURISH ACUPUNCTURE AND WELLNESS LLC
Entity type:Organization
Organization Name:FLOURISH ACUPUNCTURE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC LMT
Authorized Official - Phone:719-221-8761
Mailing Address - Street 1:1129 SW WASHINGTON ST APT 305
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2317
Mailing Address - Country:US
Mailing Address - Phone:719-221-8761
Mailing Address - Fax:
Practice Address - Street 1:917 SW OAK ST STE 308
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2806
Practice Address - Country:US
Practice Address - Phone:917-888-3602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center