MEDICARE: DR. BJ ADREZIN MS, ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	1290	OR

General Provider Information

NPI Number	:	1568642122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BJ ADREZIN MS, ND

Provider Business Mailing Address
First Line	:	5835 SW CORBETT AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5835 SW CORBETT AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3767
Country	:	US
Telephone Number	:	503-367-6763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2007
Last Update Date	:	11/11/2007

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