Provider Demographics
NPI:1679394787
Name:ATSA ACUPUNCTURE
Entity type:Organization
Organization Name:ATSA ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM, LAC
Authorized Official - Phone:541-550-9695
Mailing Address - Street 1:690 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9518
Mailing Address - Country:US
Mailing Address - Phone:541-550-9695
Mailing Address - Fax:503-845-9350
Practice Address - Street 1:690 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9518
Practice Address - Country:US
Practice Address - Phone:541-550-9695
Practice Address - Fax:503-845-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center