Provider Demographics
NPI:1225218977
Name:GUREVICH, ILANA (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:
Last Name:GUREVICH
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 1:2330 NW FLANDERS ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3442
Mailing Address - Country:US
Mailing Address - Phone:503-701-8766
Mailing Address - Fax:503-241-5484
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:STE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-701-8766
Practice Address - Fax:503-241-5484
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1580175F00000X, 175F00000X
ORAC01232171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist