Provider Demographics
NPI:1457605610
Name:RESTORATIVE HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:RESTORATIVE HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WERNER
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSLOO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-747-2021
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:17685 65TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7800
Practice Address - Country:US
Practice Address - Phone:503-747-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORATIVE HEALTH CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site