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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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