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Organization
SACRED BODY ACUPUNCTURE AND MASSAGE, LLC
Active
Organization
SACRED BODY ACUPUNCTURE AND MASSAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORINA LEE BRUCKNER LAC, MACOM (ACUPUNCTURIST, OWNER)
(503) 490-4185
Entity
Organization
Contact information
Practice address
1904 ELM ST, SUITE 4, FOREST GROVE, OR 97116-2553
(503) 490-4185
Mailing address
41613 NW BUCKSHIRE ST, BANKS, OR 97106-6006
(503) 490-4185
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC156406
OR
Other
Enumeration date
01/09/2012
Last updated
01/16/2017
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