Provider Demographics
NPI:1225281462
Name:KELIIHELEUA, TYLER (ND)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:KELIIHELEUA
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 1:15100 SW MALLARD DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9393
Mailing Address - Country:US
Mailing Address - Phone:503-246-2995
Mailing Address - Fax:503-246-1478
Practice Address - Street 1:14900 SW BARROWS RD STE 201
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-7501
Practice Address - Country:US
Practice Address - Phone:503-246-2995
Practice Address - Fax:503-246-1478
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1635175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath