Provider Demographics
NPI:1689459125
Name:NORTHWEST REGENERATIVE ORTHOPEDICS
Entity Type:Organization
Organization Name:NORTHWEST REGENERATIVE ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MITCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-737-7302
Mailing Address - Street 1:16250 SW UPPER BOONES FERRY RD STE 195
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7220
Mailing Address - Country:US
Mailing Address - Phone:503-799-6115
Mailing Address - Fax:833-606-1224
Practice Address - Street 1:16250 SW UPPER BOONES FERRY RD STE 195
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7220
Practice Address - Country:US
Practice Address - Phone:503-799-6115
Practice Address - Fax:833-606-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty