Organization
COLLEEN GIBSON ACUPUNCTURE LLC
Active
Other names
Cultivate Wellness Acupuncture & Massage
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN FRIDL GIBSON L.AC. (OWNER)
(503) 370-9073
Entity
Organization
Contact information
Practice address
4004 SE WOODSTOCK BLVD # 5, PORTLAND, OR 97202-7662
(503) 777-0444
Mailing address
3735 SE 27TH AVE, PORTLAND, OR 97202-3005
(503) 730-9073
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01136
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500641110
—
OR
Enumeration date
03/29/2017
Last updated
03/29/2017
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