Provider Demographics
NPI:1902591357
Name:DANCING ASPEN HEALING ARTS LLC
Entity Type:Organization
Organization Name:DANCING ASPEN HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER / ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CAITLYNN
Authorized Official - Middle Name:CLAIRE DIDLICK
Authorized Official - Last Name:BOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, MACOM, LAC
Authorized Official - Phone:503-913-2136
Mailing Address - Street 1:333 NW WALLULA AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5410
Mailing Address - Country:US
Mailing Address - Phone:503-913-2136
Mailing Address - Fax:
Practice Address - Street 1:22400 SE STARK ST STE 106
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2656
Practice Address - Country:US
Practice Address - Phone:503-913-2136
Practice Address - Fax:503-825-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty