Provider Demographics
NPI:1649840075
Name:ACORN WELLNESS LLC
Entity type:Organization
Organization Name:ACORN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-891-1389
Mailing Address - Street 1:16005 NW SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97231-2434
Mailing Address - Country:US
Mailing Address - Phone:503-891-1389
Mailing Address - Fax:
Practice Address - Street 1:2190 SE OAK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:OR
Practice Address - Zip Code:97267-2658
Practice Address - Country:US
Practice Address - Phone:503-891-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500740983Medicaid