Provider Demographics
NPI:1134860331
Name:BE WELL ACUPUNCTURE
Entity type:Organization
Organization Name:BE WELL ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BINGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-843-2256
Mailing Address - Street 1:3125 NE HOLLADAY ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2504
Mailing Address - Country:US
Mailing Address - Phone:917-843-2256
Mailing Address - Fax:
Practice Address - Street 1:10260 SW GREENBURG RD STE 470
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5500
Practice Address - Country:US
Practice Address - Phone:503-217-4457
Practice Address - Fax:503-662-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500725619Medicaid