Provider Demographics
NPI:1407249659
Name:NEW LEAF HEALTH CLINIC
Entity Type:Organization
Organization Name:NEW LEAF HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:971-533-1700
Mailing Address - Street 1:PO BOX 96173
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296-6003
Mailing Address - Country:US
Mailing Address - Phone:971-533-1700
Mailing Address - Fax:
Practice Address - Street 1:14900 SW BARROWS RD
Practice Address - Street 2:BUILDING B, SUITE 201
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-7524
Practice Address - Country:US
Practice Address - Phone:971-533-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1817261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center