Provider Demographics
NPI:1134368616
Name:NW HEADACHE AND WELLNESS INSTITUTE PC
Entity type:Organization
Organization Name:NW HEADACHE AND WELLNESS INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-601-0300
Mailing Address - Street 1:11786 SW BARNES RD BLDG D
Mailing Address - Street 2:STE 140
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5925
Mailing Address - Country:US
Mailing Address - Phone:503-601-0300
Mailing Address - Fax:503-601-0304
Practice Address - Street 1:11786 SW BARNES RD BLDG D
Practice Address - Street 2:STE 140
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5925
Practice Address - Country:US
Practice Address - Phone:503-601-0300
Practice Address - Fax:503-601-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty