Provider Demographics
NPI:1457056988
Name:CONSCIOUS HEALING COLLECTIVE LLC
Entity Type:Organization
Organization Name:CONSCIOUS HEALING COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GATZKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:646-740-1538
Mailing Address - Street 1:13019 SE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1435
Mailing Address - Country:US
Mailing Address - Phone:646-740-1538
Mailing Address - Fax:
Practice Address - Street 1:13019 SE LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1435
Practice Address - Country:US
Practice Address - Phone:646-740-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty