Provider Demographics
NPI:1255705133
Name:CARPENTER, CASEY ELIZABETH (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ELIZABETH
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NE BROADWAY ST STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1544
Mailing Address - Country:US
Mailing Address - Phone:971-405-0583
Mailing Address - Fax:971-279-6908
Practice Address - Street 1:2100 NE BROADWAY ST STE 225
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1544
Practice Address - Country:US
Practice Address - Phone:971-405-0583
Practice Address - Fax:971-279-6908
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3051175F00000X
ORAC173647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist