Sacred Body Acupuncture and Massage, LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC156406 Issued in OR

Legal business name

SACRED BODY ACUPUNCTURE AND MASSAGE, LLC

Practice address

1904 Elm St
Suite 4
Forest Grove, OR 97116-2553

Phone

(503) 490-4185

NPI assigned

Jan 9, 2012

Last updated

Jan 16, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Corina Lee Bruckner, LAC, MACOMNPI 1972861953

Title

Acupuncturist, Owner

Phone

(503) 490-4185

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corina Lee Bruckner, L.AC

  • Acupuncturist
  • Forest Grove, OR
  • NPI 1972861953
  NPD (past) Authorized official

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

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484524800000",
    "number": "1548530413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41613 NW BUCKSHIRE ST",
            "city": "BANKS",
            "state": "OR",
            "postal_code": "971066006",
            "telephone_number": "503-490-4185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 ELM ST",
            "address_2": "SUITE 4",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162553",
            "telephone_number": "503-490-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED BODY ACUPUNCTURE AND MASSAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-09",
        "last_updated": "2017-01-16",
        "status": "A",
        "authorized_official_last_name": "BRUCKNER",
        "authorized_official_first_name": "CORINA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ACUPUNCTURIST, OWNER",
        "authorized_official_telephone_number": "503-490-4185",
        "authorized_official_credential": "LAC, MACOM"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC156406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Keith Rowland, OD
• Erin Michelle Russell, ATC
• Rxdirect, Inc. (Jennings McCall Center Pharmacy)
• Carol Z Rymer, O.D.
• Kimberly K Sabin, DOULA ,PPD,BEC,BSC
• Safeway Inc (Safeway Pharmacy #0406)
• Adriana Sandoval
• Melinda Ann Sanfilippo, BSN, MSN, FNP-C.
• Aldrin Marcus Santamaria, OD
• Molly Dacus Saunders, D.M.D.

• Acupuncturist in Forest Grove, OR
• Providers in Forest Grove, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.