Provider Demographics
NPI:1295620813
Name:LOOM ACUPUNCTURE LLC
Entity type:Organization
Organization Name:LOOM ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:BOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:619-607-8779
Mailing Address - Street 1:735 NE ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3831
Mailing Address - Country:US
Mailing Address - Phone:619-607-8779
Mailing Address - Fax:
Practice Address - Street 1:1626 NE ALBERTA ST STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5048
Practice Address - Country:US
Practice Address - Phone:503-210-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty