Healthcare Provider Details

I. General information

NPI: 1336683341
Provider Name (Legal Business Name): SEED TO TREE NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 N HIGHWAY 97 STE 200
BEND OR
97703-7559
US

IV. Provider business mailing address

60783 RIVER BEND DR
BEND OR
97702-7909
US

V. Phone/Fax

Practice location:
  • Phone: 541-647-0655
  • Fax:
Mailing address:
  • Phone: 541-647-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC180065
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMBER LEE FISHER TROUT
Title or Position: SOLE PROPRIETOR
Credential: LAC
Phone: 541-647-0655