Provider Demographics
NPI:1689033326
Name:HEARTWOOD HEALING CENTER
Entity Type:Organization
Organization Name:HEARTWOOD HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-388-6583
Mailing Address - Street 1:29781 SW TOWN CENTER LOOP W
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8806
Mailing Address - Country:US
Mailing Address - Phone:503-388-6583
Mailing Address - Fax:
Practice Address - Street 1:29781 SW TOWN CENTER LOOP W
Practice Address - Street 2:SUITE 700
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8806
Practice Address - Country:US
Practice Address - Phone:503-388-6583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC160246261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center