Provider Demographics
NPI:1699196311
Name:THE VITAL COMPASS
Entity Type:Organization
Organization Name:THE VITAL COMPASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WORKER-OWNER, CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYLAND LLEWELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:971-373-8378
Mailing Address - Street 1:5412 N WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2740
Mailing Address - Country:US
Mailing Address - Phone:971-373-8378
Mailing Address - Fax:
Practice Address - Street 1:5412 N WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2740
Practice Address - Country:US
Practice Address - Phone:971-373-8378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150271171100000X
ORAC150088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty