Provider Demographics
NPI:1689946873
Name:NATUROMEDICINE CENTER, INC.
Entity Type:Organization
Organization Name:NATUROMEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-748-2552
Mailing Address - Street 1:11515 SW DURHAM RD STE E9
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3476
Mailing Address - Country:US
Mailing Address - Phone:503-748-2552
Mailing Address - Fax:
Practice Address - Street 1:11515 SW DURHAM RD STE E9
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3476
Practice Address - Country:US
Practice Address - Phone:503-748-2552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR55539175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty