Provider Demographics
NPI:1841302031
Name:CANAVAN, DONALD M (ND)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:CANAVAN
Suffix:
Gender:M
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-0039
Mailing Address - Country:US
Mailing Address - Phone:541-347-5626
Mailing Address - Fax:
Practice Address - Street 1:1080 DATE AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1914
Practice Address - Country:US
Practice Address - Phone:541-347-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0602175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath