Provider Demographics
NPI:1043594518
Name:ALLDERDICE, DAVE (ND)
Entity Type:Individual
Prefix:DR
First Name:DAVE
Middle Name:
Last Name:ALLDERDICE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 OSWEGO POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3228
Mailing Address - Country:US
Mailing Address - Phone:503-636-2734
Mailing Address - Fax:
Practice Address - Street 1:320 OSWEGO POINTE DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3228
Practice Address - Country:US
Practice Address - Phone:503-636-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1828175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath