Basic Information
| Provider Information | |||||||||
| NPI: | 1003150665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUNAUGH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6856 NE MULTNOMAH ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972135441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033487787 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2705 E BURNSIDE ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972141763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033487787 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC160358 | OR | Y | Other Service Providers | Acupuncturist |
No ID Information.