Provider Demographics
NPI:1881109361
Name:ADVANCED ACUPUNCTURE, INC.
Entity type:Organization
Organization Name:ADVANCED ACUPUNCTURE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOOSHIN
Authorized Official - Middle Name:NIKKI
Authorized Official - Last Name:MEDGHALCHY
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:360-571-8515
Mailing Address - Street 1:9411 NE HIGHWAY 99
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8970
Mailing Address - Country:US
Mailing Address - Phone:360-571-8515
Mailing Address - Fax:360-571-8516
Practice Address - Street 1:9411 NE HIGHWAY 99 STE 1
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8970
Practice Address - Country:US
Practice Address - Phone:360-571-8515
Practice Address - Fax:360-571-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X, 171100000X
WAAC00000606261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1801876321OtherACUPUNCTURE