Provider Demographics
NPI:1063685543
Name:NORTHWEST NATURAL MEDICINE, LLC
Entity Type:Organization
Organization Name:NORTHWEST NATURAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:BUTTLER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-786-2181
Mailing Address - Street 1:2305 SE WASHINGTON STREET.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7467
Mailing Address - Country:US
Mailing Address - Phone:503-786-2181
Mailing Address - Fax:503-200-2259
Practice Address - Street 1:2305 SE WASHINGTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7647
Practice Address - Country:US
Practice Address - Phone:503-786-2181
Practice Address - Fax:503-200-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1592175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty