Provider Demographics
NPI:1487343299
Name:IKIGAI WELLNESS LLC
Entity type:Organization
Organization Name:IKIGAI WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HOMER-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS, MSOM, LAC
Authorized Official - Phone:503-308-8676
Mailing Address - Street 1:10962 SW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3600
Mailing Address - Country:US
Mailing Address - Phone:503-539-8533
Mailing Address - Fax:503-821-7881
Practice Address - Street 1:9600 SW OAK ST STE 410
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6581
Practice Address - Country:US
Practice Address - Phone:503-308-8676
Practice Address - Fax:503-821-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty