Provider Demographics
NPI:1508216862
Name:JADE NATUROPATHIC MEDICINE
Entity Type:Organization
Organization Name:JADE NATUROPATHIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKINZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-621-1883
Mailing Address - Street 1:2955 N HWY 97 STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2955 N HWY 97 STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7559
Practice Address - Country:US
Practice Address - Phone:541-621-1883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3095175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty