Provider Demographics
NPI:1538406889
Name:COLUMBIA RIVER ACUPUNCTURE LLC
Entity type:Organization
Organization Name:COLUMBIA RIVER ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FROEHLICH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-806-6767
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:MOSIER
Mailing Address - State:OR
Mailing Address - Zip Code:97040-0312
Mailing Address - Country:US
Mailing Address - Phone:541-386-8767
Mailing Address - Fax:541-478-0119
Practice Address - Street 1:302 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:MOSIER
Practice Address - State:OR
Practice Address - Zip Code:97040-1500
Practice Address - Country:US
Practice Address - Phone:541-386-8767
Practice Address - Fax:541-478-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00478261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center