Provider Demographics
NPI:1972776029
Name:HEALING RIVER CLINIC OF ACUPUNCTURE AND MASSAGE
Entity type:Organization
Organization Name:HEALING RIVER CLINIC OF ACUPUNCTURE AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:503-690-3215
Mailing Address - Street 1:15285 NW CENTRAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-0973
Mailing Address - Country:US
Mailing Address - Phone:503-690-3215
Mailing Address - Fax:503-690-3291
Practice Address - Street 1:15285 NW CENTRAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-0973
Practice Address - Country:US
Practice Address - Phone:503-690-3215
Practice Address - Fax:503-690-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00932171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty