Provider Demographics
NPI:1194102194
Name:ANJUNA ACUPUNCTURE & INTEGRATED MEDICINE
Entity type:Organization
Organization Name:ANJUNA ACUPUNCTURE & INTEGRATED MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-240-6497
Mailing Address - Street 1:656 CHARNELTON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2689
Mailing Address - Country:US
Mailing Address - Phone:619-240-6497
Mailing Address - Fax:541-343-1455
Practice Address - Street 1:656 CHARNELTON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2689
Practice Address - Country:US
Practice Address - Phone:619-240-6497
Practice Address - Fax:541-343-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC164157171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORAC169614OtherOREGON MEDICAL BOARD
ORAC164157OtherOREGON MEDICAL BOARD