Provider Demographics
NPI:1215375142
Name:NW FAMILY WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:NW FAMILY WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-887-7725
Mailing Address - Street 1:10365 SE SUNNYSIDE RD
Mailing Address - Street 2:STE 210
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5741
Mailing Address - Country:US
Mailing Address - Phone:503-887-7725
Mailing Address - Fax:503-406-2550
Practice Address - Street 1:10117 SE SUNNYSIDE RD
Practice Address - Street 2:STE F709
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7708
Practice Address - Country:US
Practice Address - Phone:503-887-7725
Practice Address - Fax:503-406-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty