Provider Demographics
NPI:1346315801
Name:J BLACK NO LLC
Entity Type:Organization
Organization Name:J BLACK NO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:NO
Authorized Official - Phone:503-883-0333
Mailing Address - Street 1:2270 NE MCDANIEL LANE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-883-0333
Mailing Address - Fax:503-883-0330
Practice Address - Street 1:2270 NE MCDANIEL LANE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-883-0333
Practice Address - Fax:503-883-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1263175F00000X
OR1269175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty