Provider Demographics
NPI:1205913431
Name:BORG, ADRIENNE MARY (ND)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:MARY
Last Name:BORG
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 1:74 E 18TH AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4081
Mailing Address - Country:US
Mailing Address - Phone:541-686-3330
Mailing Address - Fax:541-465-4785
Practice Address - Street 1:74 E 18TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4081
Practice Address - Country:US
Practice Address - Phone:541-686-3330
Practice Address - Fax:541-465-4785
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR691175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR050018Medicaid