Provider Demographics
NPI:1013218502
Name:GRADY, MICHAEL CORY (ND)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CORY
Last Name:GRADY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9500 SW BARBUR BLVD
Mailing Address - Street 2:STE 116
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5466
Mailing Address - Country:US
Mailing Address - Phone:971-227-7080
Mailing Address - Fax:503-465-3797
Practice Address - Street 1:9500 SW BARBUR BLVD
Practice Address - Street 2:STE 116
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5466
Practice Address - Country:US
Practice Address - Phone:971-227-7080
Practice Address - Fax:503-465-3797
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1779175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath