Provider Demographics
NPI:1780916502
Name:SEAL, BONNY E (ND)
Entity type:Individual
Prefix:DR
First Name:BONNY
Middle Name:E
Last Name:SEAL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 BOONES FERRY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3455
Mailing Address - Country:US
Mailing Address - Phone:503-967-3455
Mailing Address - Fax:503-974-3797
Practice Address - Street 1:15630 BOONES FERRY RD STE 6
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3455
Practice Address - Country:US
Practice Address - Phone:503-967-3455
Practice Address - Fax:503-974-3797
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1727175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath