Provider Demographics
NPI:1902201130
Name:RADIANT HEART CENTER FOR WHOLENESS
Entity Type:Organization
Organization Name:RADIANT HEART CENTER FOR WHOLENESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:EMIKO
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-227-3899
Mailing Address - Street 1:2403 SE MONROE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7646
Mailing Address - Country:US
Mailing Address - Phone:503-303-4078
Mailing Address - Fax:
Practice Address - Street 1:2403 SE MONROE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7646
Practice Address - Country:US
Practice Address - Phone:503-303-4078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152866171100000X
OR1576175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty