Provider Demographics
NPI:1821080789
Name:KADISH, ALAN (NMD, ND)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:KADISH
Suffix:
Gender:M
Credentials:NMD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 NW CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9577
Mailing Address - Country:US
Mailing Address - Phone:541-773-3191
Mailing Address - Fax:541-779-5647
Practice Address - Street 1:1156 NW CHARLEMAGNE PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3626
Practice Address - Country:US
Practice Address - Phone:541-773-3191
Practice Address - Fax:541-779-5647
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59-547175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR196543Medicaid