Provider Demographics
NPI:1326327206
Name:BLACKBIRD NATURAL HEALTH, LLC
Entity Type:Organization
Organization Name:BLACKBIRD NATURAL HEALTH, LLC
Other - Org Name:BLACKBIRD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-227-8700
Mailing Address - Street 1:4425 SW CORBETT AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4260
Mailing Address - Country:US
Mailing Address - Phone:503-227-8700
Mailing Address - Fax:503-227-8702
Practice Address - Street 1:4425 SW CORBETT AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4260
Practice Address - Country:US
Practice Address - Phone:503-227-8700
Practice Address - Fax:503-227-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty