Organization · NPI-2

Antara Acupuncture And Herbal Clinic LLC

Acupuncturist · Gresham, OR

NPI number1356692115
StatusActive
Last updated in NPPESSep 19, 2012

Details

NPI
1356692115
Entity type
Organization (NPI-2)
Legal business name
Antara Acupuncture And Herbal Clinic LLC
Organization subpart
No
Enumeration date
Sep 19, 2012
Last updated
Sep 19, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171100000X Acupuncturist150593ORYes

Practice location

130 Nw Miller Ave
Gresham, OR 97030-7226

Phone 503-665-2344 · Fax 503-665-2337

Mailing address

130 Nw Miller Ave
Gresham, OR 97030-7226

Phone 503-665-2344 · Fax 503-665-2337

Authorized official

Katelyn Decker
Owner/Licensed Acupuncturist
9712351171

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