Provider Demographics
NPI:1578607016
Name:LANDI, KIM MICHELE (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MICHELE
Last Name:LANDI
Suffix:
Gender:F
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3134
Mailing Address - Country:US
Mailing Address - Phone:503-642-5094
Mailing Address - Fax:503-642-5307
Practice Address - Street 1:3165 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3134
Practice Address - Country:US
Practice Address - Phone:503-642-5094
Practice Address - Fax:503-642-5307
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR823175F00000X
OR2474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor