Provider Demographics
NPI:1528408291
Name:LEVY, STEPHEN PHILIP (ND, LAC, LMT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PHILIP
Last Name:LEVY
Suffix:
Gender:M
Credentials:ND, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 SE MILLER ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6873
Mailing Address - Country:US
Mailing Address - Phone:503-720-7418
Mailing Address - Fax:
Practice Address - Street 1:1221 SE MADISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3890
Practice Address - Country:US
Practice Address - Phone:503-445-7767
Practice Address - Fax:503-459-4221
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC157837171100000X
OR1893175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist