Organization
THERAPEUTIC ACUPUNTURE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA PELTON (GENERAL MANAGER)
(503) 309-8252
Entity
Organization
Contact information
Practice address
17355 BOONES FERRY RD STE B, LAKE OSWEGO, OR 97035-5225
(503) 309-8252
Mailing address
17355 BOONES FERRY RD STE B, LAKE OSWEGO, OR 97035-5225
(503) 309-8252
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC01167
OREGON MEDICAL BOARD
OR
Enumeration date
07/25/2014
Last updated
07/25/2014
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