Provider Demographics
NPI:1699945410
Name:BLUE SKY ACUPUNCTURE, LLC
Entity type:Organization
Organization Name:BLUE SKY ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-474-7446
Mailing Address - Street 1:330 SE BAKER ST.
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-474-7446
Mailing Address - Fax:866-454-3484
Practice Address - Street 1:330 SE BAKER ST.
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-474-7446
Practice Address - Fax:866-454-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01147171100000X
ORAC153240171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty