Organization
ANTARA ACUPUNCTURE AND HERBAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATELYN DECKER L.AC., M.AC.O.M. (OWNER/LICENSED ACUPUNCTURIST)
(971) 235-1171
Entity
Organization
Contact information
Practice address
130 NW MILLER AVE, GRESHAM, OR 97030-7226
(503) 665-2344
(503) 665-2337
Mailing address
130 NW MILLER AVE, GRESHAM, OR 97030-7226
(503) 665-2344
(503) 665-2337
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
150593
OR
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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