Provider Demographics
NPI:1346447166
Name:DDN ENTERPRISES LLC
Entity Type:Organization
Organization Name:DDN ENTERPRISES LLC
Other - Org Name:OREGON WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NOWACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-526-8600
Mailing Address - Street 1:4265 SW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3028
Mailing Address - Country:US
Mailing Address - Phone:503-526-8600
Mailing Address - Fax:503-643-1006
Practice Address - Street 1:4265 SW 109TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3028
Practice Address - Country:US
Practice Address - Phone:503-526-8600
Practice Address - Fax:503-643-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273359111N00000X
OR1419175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU35217Medicare UPIN
ORR133176Medicare PIN