Provider Demographics
NPI:1265786636
Name:SUSAN BUHLER
Entity type:Organization
Organization Name:SUSAN BUHLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-216-9913
Mailing Address - Street 1:7919 SE HENRY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6332
Mailing Address - Country:US
Mailing Address - Phone:971-216-9913
Mailing Address - Fax:
Practice Address - Street 1:15645 SE 114TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9047
Practice Address - Country:US
Practice Address - Phone:503-303-4143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty