Provider Demographics
NPI:1639507965
Name:KELLY RAYLINSKY
Entity Type:Organization
Organization Name:KELLY RAYLINSKY
Other - Org Name:KELLY RAYLINSKY
Other - Org Type:Other Name
Authorized Official - Title/Position:NATUROPATHIC DOCOTR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RAYLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:603-205-2311
Mailing Address - Street 1:2604 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1756
Mailing Address - Country:US
Mailing Address - Phone:603-205-2311
Mailing Address - Fax:
Practice Address - Street 1:511 SW 10TH AVE STE 801
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2709
Practice Address - Country:US
Practice Address - Phone:503-230-8973
Practice Address - Fax:503-230-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1895261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care