Colleen Gibson Acupuncture LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC01136 Issued in OR

Legal business name

COLLEEN GIBSON ACUPUNCTURE LLC

Practice address

4004 SE Woodstock Blvd # 5
Portland, OR 97202-7662

Phone

(503) 777-0444

NPI assigned

Mar 29, 2017

Organization subpart

No

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

Authorized official

Name

Colleen Fridl Gibson, L.AC.NPI 1366624413

Title

Owner

Phone

(503) 370-9073

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cultivate Wellness Acupuncture & Massage Doing business as

Locations

Practitioners 1

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

• Colleen Fridl Gibson, L.AC.

  • Acupuncturist
  • Portland, OR
  • NPI 1366624413
  NPD (past) Authorized official

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1285166322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3735 SE 27TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972023005",
            "telephone_number": "503-730-9073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 SE WOODSTOCK BLVD # 5",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027662",
            "telephone_number": "503-777-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEEN GIBSON ACUPUNCTURE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "FRIDL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-370-9073",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC01136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641110",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cultivate Wellness Acupuncture & Massage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 29, 2017; 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.