NPIMap

Organization Active NPI

Iris Acupuncture Clinic LLC

  • Acupuncturist
  • Portland, OR
National Provider Identifier
1063395044
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
Legal business name
IRIS ACUPUNCTURE CLINIC LLC
Practice address
129 NE 102ND Ave Ste a
Portland, OR 97220-4102
Phone
(503) 837-6655
Fax
(866) 539-5513
NPI assigned
Jul 28, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sallie A McKibben, LACNPI 1124439492
Title
Owner, Licensed Acupuncturist
Phone
(503) 837-6655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193400000X SINGLE SPECIALTY GROUP 171100000X Primary

Addresses

Primary practice location

129 NE 102ND Ave Ste a
Portland, OR 97220-4102

Mailing address

11954 NE Glisan St # 327
Portland, OR 97220-2143
Phone (503) 837-6655

National Provider Directory

National Provider Directory

Locations

11954 NE Glisan St
Portland, OR 97220

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1063395044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11954 NE GLISAN ST # 327",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972202143",
            "telephone_number": "503-837-6655",
            "fax_number": "866-539-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 NE 102ND AVE STE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972204102",
            "telephone_number": "503-837-6655",
            "fax_number": "866-539-5513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRIS ACUPUNCTURE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-28",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "MCKIBBEN",
        "authorized_official_first_name": "SALLIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER, LICENSED ACUPUNCTURIST",
        "authorized_official_telephone_number": "503-837-6655",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.