Provider Demographics
NPI:1629676069
Name:TREE ROOT MEDICINE
Entity Type:Organization
Organization Name:TREE ROOT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTIN
Authorized Official - Middle Name:BEAL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND, ATC
Authorized Official - Phone:619-990-2954
Mailing Address - Street 1:PO BOX 8196
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8196
Mailing Address - Country:US
Mailing Address - Phone:971-220-8627
Mailing Address - Fax:
Practice Address - Street 1:7175 SW BEVELAND RD STE 105
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8665
Practice Address - Country:US
Practice Address - Phone:503-244-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty