Provider Demographics
NPI:1609473628
Name:ALSTON, KHALEED (ND)
Entity Type:Individual
Prefix:DR
First Name:KHALEED
Middle Name:
Last Name:ALSTON
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 1:5737 SW NEVADA CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1248
Mailing Address - Country:US
Mailing Address - Phone:917-494-4847
Mailing Address - Fax:
Practice Address - Street 1:4424 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2331
Practice Address - Country:US
Practice Address - Phone:503-477-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4340172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath