Provider Demographics
NPI:1518307735
Name:CHILDREN'S NATUROPATHIC CENTRE PC
Entity Type:Organization
Organization Name:CHILDREN'S NATUROPATHIC CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MCALLISTER ULBRICHT
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-224-2590
Mailing Address - Street 1:4444 SW CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4207
Mailing Address - Country:US
Mailing Address - Phone:503-224-2590
Mailing Address - Fax:503-224-2592
Practice Address - Street 1:4444 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4207
Practice Address - Country:US
Practice Address - Phone:503-224-2590
Practice Address - Fax:503-224-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR54965175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1356418776OtherNPI