Organization
HAWTHORNE ACUPUNCTURE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE JAN L.AC (ACUPUNCTURIST)
(503) 236-9609
Entity
Organization
Contact information
Practice address
4531 SE BELMONT ST STE 203, PORTLAND, OR 97215-1675
(503) 236-9609
(503) 236-2906
Mailing address
4531 SE BEMONT ST, STE 203, PORTLAND, OR 97215-1675
(503) 236-9609
(503) 236-2906
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC164280
OR
171100000X
Acupuncturist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500689108
—
OR
Enumeration date
06/30/2015
Last updated
07/26/2022
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