Provider Demographics
NPI:1720397011
Name:CENTER DOWN LLC
Entity Type:Organization
Organization Name:CENTER DOWN LLC
Other - Org Name:PDX ACU-BIRTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GAMACHE
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:609-477-9192
Mailing Address - Street 1:6214 SE 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7029
Mailing Address - Country:US
Mailing Address - Phone:609-477-9192
Mailing Address - Fax:
Practice Address - Street 1:4004 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7662
Practice Address - Country:US
Practice Address - Phone:503-777-0444
Practice Address - Fax:503-777-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01275171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500616924Medicaid