Provider Demographics
NPI:1427469642
Name:IMMERSION ENTERPRISES LLC
Entity type:Organization
Organization Name:IMMERSION ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NIGH
Authorized Official - Suffix:
Authorized Official - Credentials:ND/LAC
Authorized Official - Phone:503-719-4806
Mailing Address - Street 1:1221 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3890
Mailing Address - Country:US
Mailing Address - Phone:503-719-4806
Mailing Address - Fax:
Practice Address - Street 1:1221 SE MADISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3890
Practice Address - Country:US
Practice Address - Phone:503-719-4806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty