Provider Demographics
NPI:1841624194
Name:KRISHNA AVALON ACUPUNCTURE, INC
Entity type:Organization
Organization Name:KRISHNA AVALON ACUPUNCTURE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVALON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-522-2872
Mailing Address - Street 1:4816 NE GOING ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218
Mailing Address - Country:US
Mailing Address - Phone:503-522-2872
Mailing Address - Fax:844-252-8069
Practice Address - Street 1:4605 NE FREMONT ST
Practice Address - Street 2:STE 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213
Practice Address - Country:US
Practice Address - Phone:503-522-2872
Practice Address - Fax:844-252-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty