Provider Demographics
NPI:1508317512
Name:LANGLAIS, JUSTIN (ND)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:LANGLAIS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25195 SW PARKWAY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9689
Mailing Address - Country:US
Mailing Address - Phone:503-438-7738
Mailing Address - Fax:
Practice Address - Street 1:25195 SW PARKWAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-438-7738
Practice Address - Fax:833-969-0083
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4031175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500735392Medicaid