Vidhra Maureen Jackiw, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC169857 Issued in OR

Practice address

1623 SE 6TH Ave Ste 200
Portland, OR 97214-3502

Phone

(971) 350-8508

Fax

(971) 275-1552

NPI assigned

Oct 5, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Open Sky Natural Medicine, LLC

  • Acupuncturist
  • Portland, OR
  • NPI 1225817356
  NPD Authorized official

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

{
    "created_epoch": "1412467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1154724193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 SE 6TH AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143502",
            "telephone_number": "971-350-8508",
            "fax_number": "971-275-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 SE 6TH AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143502",
            "telephone_number": "971-350-8508",
            "fax_number": "971-275-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKIW",
        "first_name": "VIDHRA",
        "middle_name": "MAUREEN",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-05",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC169857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500773023",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J2.0, LLC
• Farid Jabbari
• Reem Jaber, LMT
• Jennifer Jablin, NP
• Anna Jablonski, LPC-A
• Megan Elizabeth Jacklin, CNM
• Aimee Leona Jackson, PHYSICAL THERAPIST
• Allison Jackson
• Angela Rae Jackson, LAC
• April Charee Jackson, LCSW

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.