Provider Demographics
NPI:1336545144
Name:EAST BY NORTHWEST INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:EAST BY NORTHWEST INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MALEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACODRUM
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-754-5397
Mailing Address - Street 1:3718 SE 33RD PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:516 SE MORRISON ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2327
Practice Address - Country:US
Practice Address - Phone:503-239-1022
Practice Address - Fax:503-512-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2071175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty