Healthcare Provider Details

I. General information

NPI: 1487775656
Provider Name (Legal Business Name): MITCHELL BEBEL STARGROVE N.D., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 SW WATSON AVE
BEAVERTON OR
97005-0511
US

IV. Provider business mailing address

4720 SW WATSON AVE
BEAVERTON OR
97005-0511
US

V. Phone/Fax

Practice location:
  • Phone: 503-526-0397
  • Fax: 503-643-4633
Mailing address:
  • Phone: 503-526-0397
  • Fax: 503-643-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number95
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number696
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: