Organization
ANCIENT FERN MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY NICHOLAS NELSON L.AC. (OWNER)
(971) 227-2773
Entity
Organization
Contact information
Practice address
2926 NE FLANDERS ST STE 2C, PORTLAND, OR 97232-3259
(971) 227-2773
(971) 275-1961
Mailing address
2926 NE FLANDERS ST STE 2C, PORTLAND, OR 97232-3259
(971) 227-2773
(971) 275-1961
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC161759
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500669071
—
OR
01
—
AC161759
OREGON MEDICAL BOARD
OR
Enumeration date
07/08/2016
Last updated
07/08/2016
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