Provider Demographics
NPI:1568728129
Name:HALVERSON, MARLEN I JR (ND)
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:I
Last Name:HALVERSON
Suffix:JR
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 1:3101 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4601
Mailing Address - Country:US
Mailing Address - Phone:503-206-6996
Mailing Address - Fax:888-959-9018
Practice Address - Street 1:8375 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2252
Practice Address - Country:US
Practice Address - Phone:503-206-6996
Practice Address - Fax:888-959-9018
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1885175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath