Provider Demographics
NPI:1225370083
Name:LAKE OSWEGO HEALTH CENTER
Entity Type:Organization
Organization Name:LAKE OSWEGO HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARMA
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:DENMARK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-505-9806
Mailing Address - Street 1:470 6TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2902
Mailing Address - Country:US
Mailing Address - Phone:503-505-9806
Mailing Address - Fax:
Practice Address - Street 1:470 6TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2902
Practice Address - Country:US
Practice Address - Phone:503-505-9806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1667175F00000X
OR1429175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty