| |
23479 Se Stark St, Gresham, OR 97030-2962 | |
(503) 667-9300 | |
(503) 667-4975 |
Full Name | |
---|---|
Type | Facility |
Speciality | Clinic/center - Multi-specialty |
Location | 23479 Se Stark St, Gresham, Oregon |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1306003645 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 3026 (Oregon) | Secondary |
175F00000X | Naturopath | 0932 (Oregon) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | 23982 (Oregon) | Primary |
Mailing Address | Practice Location Address |
---|---|
23479 Se Stark St, Gresham, OR 97030-2962 Ph: (503) 667-9300 | 23479 Se Stark St, Gresham, OR 97030-2962 Ph: (503) 667-9300 |