Provider Demographics
NPI:1407029234
Name:KELLEY R REIS LLC
Entity Type:Organization
Organization Name:KELLEY R REIS LLC
Other - Org Name:THE NATURAL MEDICINE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-693-0904
Mailing Address - Street 1:172 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4129
Mailing Address - Country:US
Mailing Address - Phone:503-693-0904
Mailing Address - Fax:
Practice Address - Street 1:172 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4129
Practice Address - Country:US
Practice Address - Phone:503-693-0904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1388175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty