1871738682 NPI number — HEALING RESPONSE ACUPUNCTURE & INTEGRATIVE MEDICINE

Table of content: (NPI 1871738682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871738682 NPI number — HEALING RESPONSE ACUPUNCTURE & INTEGRATIVE MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING RESPONSE ACUPUNCTURE & INTEGRATIVE MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALING RESPONSE ACUPUNCTURE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871738682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
461 NE GREENWOOD AVE.
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701-4607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-233-9352
Provider Business Mailing Address Fax Number:
971-256-8865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
461 NE GREENWOOD AVE.
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-233-9352
Provider Business Practice Location Address Fax Number:
971-256-8865
Provider Enumeration Date:
12/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WOLF
Authorized Official First Name:
AMY
Authorized Official Middle Name:
AYLA
Authorized Official Title or Position:
LICENSED ACUPUNCTURIST
Authorized Official Telephone Number:
541-233-9352

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC01012 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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