Provider Demographics
NPI:1073690806
Name:VICKERS, EDYTHE MARSH (ND,LAC)
Entity Type:Individual
Prefix:DR
First Name:EDYTHE
Middle Name:MARSH
Last Name:VICKERS
Suffix:
Gender:F
Credentials:ND,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 NW LOVEJOY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3022
Mailing Address - Country:US
Mailing Address - Phone:503-224-7224
Mailing Address - Fax:503-224-1345
Practice Address - Street 1:2348 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3022
Practice Address - Country:US
Practice Address - Phone:503-224-7224
Practice Address - Fax:503-224-1345
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00078171100000X
OR0688175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist