Provider Demographics
NPI:1801273982
Name:BLUE STAR NATUROPATHIC CLINIC PC
Entity type:Organization
Organization Name:BLUE STAR NATUROPATHIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKARPERUD
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:541-389-6935
Mailing Address - Street 1:25 NW LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3294
Mailing Address - Country:US
Mailing Address - Phone:541-389-6935
Mailing Address - Fax:541-388-4966
Practice Address - Street 1:25 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3294
Practice Address - Country:US
Practice Address - Phone:541-389-6935
Practice Address - Fax:541-388-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1407175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty