Provider Demographics
NPI:1346378288
Name:HEALTH ROOTS NATURAL MEDICINE LLC
Entity Type:Organization
Organization Name:HEALTH ROOTS NATURAL MEDICINE LLC
Other - Org Name:HEALTH ROOTS NATURAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:503-772-1700
Mailing Address - Street 1:4625 SE CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4625 SE CENTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3251
Practice Address - Country:US
Practice Address - Phone:503-772-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00835171100000X
ORAC00647171100000X
OR1366175F00000X
OR1125175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty