Provider Demographics
NPI:1407029457
Name:BEAVERTON NATUROPATHIC MEDICINE
Entity Type:Organization
Organization Name:BEAVERTON NATUROPATHIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:PEABODY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-643-1024
Mailing Address - Street 1:4085 SW 109TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3000
Mailing Address - Country:US
Mailing Address - Phone:503-643-1024
Mailing Address - Fax:
Practice Address - Street 1:4085 SW 109TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3000
Practice Address - Country:US
Practice Address - Phone:503-643-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0704175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty