Provider Demographics
NPI:1770158354
Name:ACUPUNCTURE CENTER OF PORTLAND EAST LLC
Entity type:Organization
Organization Name:ACUPUNCTURE CENTER OF PORTLAND EAST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BONNICHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-841-5323
Mailing Address - Street 1:3701 SE MILWAUKIE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3835
Mailing Address - Country:US
Mailing Address - Phone:503-223-2845
Mailing Address - Fax:503-525-2516
Practice Address - Street 1:3701 SE MILWAUKIE AVE STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3835
Practice Address - Country:US
Practice Address - Phone:503-841-5323
Practice Address - Fax:503-525-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty