Provider Demographics
NPI:1093162547
Name:ACUPUNCTURE AND HERBAL MEDICAL CENTER
Entity type:Organization
Organization Name:ACUPUNCTURE AND HERBAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-476-4611
Mailing Address - Street 1:910 NE D ST
Mailing Address - Street 2:STE 104
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2325
Mailing Address - Country:US
Mailing Address - Phone:541-476-4611
Mailing Address - Fax:
Practice Address - Street 1:910 NE D ST
Practice Address - Street 2:STE 104
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2325
Practice Address - Country:US
Practice Address - Phone:541-476-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00085171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty