Provider Demographics
NPI:1902041965
Name:SUMMIT NATURAL HEALTH, LLC
Entity Type:Organization
Organization Name:SUMMIT NATURAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-230-8973
Mailing Address - Street 1:511 SW 10TH AVE
Mailing Address - Street 2:SUITE 801
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2732
Mailing Address - Country:US
Mailing Address - Phone:503-230-8973
Mailing Address - Fax:503-230-8978
Practice Address - Street 1:511 SW 10TH AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2732
Practice Address - Country:US
Practice Address - Phone:503-230-8973
Practice Address - Fax:503-230-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1631261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service