Antara Acupuncture and Herbal Clinic LLC
Organization Active NPI Acupuncturist · Gresham, OR
NPI 1356692115 · NPPES record last updated Sep 19, 2012
Key facts
- NPI
- 1356692115
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Acupuncturist 171100000X
- License
- 150593 (OR)
- Legal business name
- ANTARA ACUPUNCTURE AND HERBAL CLINIC LLC
- Practice address
- 130 NW Miller Ave
Gresham, OR 97030-7226 - Phone
- (503) 665-2344
- Fax
- (503) 665-2337
- NPI assigned
- Sep 19, 2012
- Organization subpart
- No
Authorized official
- Name
- Katelyn Decker, L.AC., M.AC.O.M.
- Title
- Owner/Licensed Acupuncturist
- Phone
- (971) 235-1171
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist |
171100000X | 150593 | OR | Yes |
Addresses
Primary practice location
130 NW Miller Ave
Gresham, OR 97030-7226
Mailing address
130 NW Miller Ave
Gresham, OR 97030-7226
Phone (503) 665-2344
Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.