Provider Demographics
NPI:1477666907
Name:ILSLEY, JUSTIN YOHALEM (ND)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:YOHALEM
Last Name:ILSLEY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8925 N HODGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3457
Mailing Address - Country:US
Mailing Address - Phone:503-735-3777
Mailing Address - Fax:
Practice Address - Street 1:4631 N ALBINA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-3011
Practice Address - Country:US
Practice Address - Phone:503-282-5358
Practice Address - Fax:503-735-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00836171100000X
OR1400175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath