Provider Demographics
NPI:1104099449
Name:ACUPUNCTURE CENTER,PC
Entity type:Organization
Organization Name:ACUPUNCTURE CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC OMD
Authorized Official - Phone:503-371-8770
Mailing Address - Street 1:1880 LANCASTER DR NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1089
Mailing Address - Country:US
Mailing Address - Phone:503-371-8770
Mailing Address - Fax:503-371-8770
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:SUITE 111
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1089
Practice Address - Country:US
Practice Address - Phone:503-371-8770
Practice Address - Fax:503-371-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty