Provider Demographics
NPI:1770904187
Name:PORTLAND ACUPUNCTURE GROUP
Entity type:Organization
Organization Name:PORTLAND ACUPUNCTURE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST, RN
Authorized Official - Prefix:
Authorized Official - First Name:FELICITY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOEBKENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MACOM, RN, BSN
Authorized Official - Phone:971-317-0222
Mailing Address - Street 1:11790 SW BARNES RD BLDG A
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5934
Mailing Address - Country:US
Mailing Address - Phone:971-317-0222
Mailing Address - Fax:971-319-0223
Practice Address - Street 1:11790 SW BARNES RD BLDG A
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5934
Practice Address - Country:US
Practice Address - Phone:971-317-0222
Practice Address - Fax:971-317-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR157441261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center