Provider Demographics
NPI:1790197531
Name:LULA HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:LULA HEALTH CENTER, LLC
Other - Org Name:LULA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:PLUMB
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-766-3664
Mailing Address - Street 1:1831 SE 7TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3578
Mailing Address - Country:US
Mailing Address - Phone:503-766-3664
Mailing Address - Fax:503-218-0987
Practice Address - Street 1:1831 SE 7TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3578
Practice Address - Country:US
Practice Address - Phone:503-766-3664
Practice Address - Fax:503-218-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3921111N00000X
OR5158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty