Provider Demographics
NPI:1467655241
Name:MADDOX, ADAM H (ND, NMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:H
Last Name:MADDOX
Suffix:
Gender:M
Credentials:ND, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 SW 67TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8963
Mailing Address - Country:US
Mailing Address - Phone:503-928-6505
Mailing Address - Fax:
Practice Address - Street 1:11850 SW 67TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8963
Practice Address - Country:US
Practice Address - Phone:503-241-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1276175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath