Provider Demographics
NPI:1104070168
Name:MARTIN, JUNIPER (ND)
Entity type:Individual
Prefix:DR
First Name:JUNIPER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 SW GREENBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6464
Mailing Address - Country:US
Mailing Address - Phone:971-328-0071
Mailing Address - Fax:503-443-2142
Practice Address - Street 1:11845 SW GREENBURG RD STE 110
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6464
Practice Address - Country:US
Practice Address - Phone:971-328-0071
Practice Address - Fax:503-443-2142
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1621202D00000X, 207Q00000X, 208D00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500648182Medicaid