Illumination Rock Integrative Medicine, Llc
LBN: Illumination Rock Integrative Medicine, Llc
Illumination Rock Integrative Medicine, Llc is an health care organization with primary practice located at 4035 Se 52Nd Ave Ste B , Portland OR 97206-3913. The organization recently has 6 registered licenses in different health care specialties including Other Service Providers / Acupuncturist, Other Service Providers / Naturopath, Allopathic & Osteopathic Physicians / Neuromuscular Medicine, Allopathic & Osteopathic Physicians / Pain Medicine, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist, Ambulatory Health Care Facilities / Clinic/Center. Ambulatory Health Care Facilities / Clinic/Center is the primary health care specialty.
Illumination Rock Integrative Medicine, Llc can be contacted via phone (503) 482-7556, or through Isakson, Kirsten Karen via phone (971) 229-2140.
Contact Information
Primary practice address
4035 Se 52Nd Ave Ste B
Portland OR 97206-3913
Phone: (503) 482-7556
Fax: (971) 244-9171
Website:
Authorized official contact:
Name: Isakson, Kirsten Karen Licensed Acupuncturist (LAC)
Phone: (971) 229-2140
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Acupuncturist | 171100000X | ||
| Other Service Providers / Naturopath | 175F00000X | ||
| Allopathic & Osteopathic Physicians / Neuromuscular Medicine | 2081N0008X | ||
| Allopathic & Osteopathic Physicians / Pain Medicine | 2081P2900X | ||
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist | 225700000X | ||
| Ambulatory Health Care Facilities / Clinic/Center | 261Q00000X |
Profile Details
| NPI number | 1356905855 |
|---|---|
| LBN Legal business name | Illumination Rock Integrative Medicine, Llc |
| DBA Doing business as | |
| Authorized official | Isakson, Kirsten Karen Licensed Acupuncturist (LAC) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 30th, 2019 |
| Last updated | Mar 30th, 2022 - about 2 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356905855 | NPPES |
| Other | 1932568458 | NPI TYPE 1 | |
| MEDICAID | 500703138 | NPI TYPE 1 |
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