Provider Demographics
NPI:1407641574
Name:STUMPTOWN ACUPUNCTURE LLC
Entity type:Organization
Organization Name:STUMPTOWN ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SASAO-RUEF
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:971-417-6205
Mailing Address - Street 1:1110 SE ALDER ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2400
Mailing Address - Country:US
Mailing Address - Phone:971-417-6205
Mailing Address - Fax:
Practice Address - Street 1:1110 SE ALDER ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2400
Practice Address - Country:US
Practice Address - Phone:971-417-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty