Provider Demographics
NPI:1427016583
Name:HEALING PATH HOLISTIC MEDICINE CLINIC, LLC
Entity Type:Organization
Organization Name:HEALING PATH HOLISTIC MEDICINE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDELVELD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-513-4665
Mailing Address - Street 1:3880 SE HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5854
Mailing Address - Country:US
Mailing Address - Phone:503-513-4665
Mailing Address - Fax:
Practice Address - Street 1:3880 SE HARRISON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5854
Practice Address - Country:US
Practice Address - Phone:503-513-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty