Provider Demographics
NPI:1922484401
Name:MEDICAL WELLNESS CARE
Entity Type:Organization
Organization Name:MEDICAL WELLNESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-389-5545
Mailing Address - Street 1:1359 NE 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1941
Mailing Address - Country:US
Mailing Address - Phone:503-389-5545
Mailing Address - Fax:888-847-1238
Practice Address - Street 1:1359 NE 35TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1941
Practice Address - Country:US
Practice Address - Phone:503-389-5545
Practice Address - Fax:888-847-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty