Healthcare Provider Details

I. General information

NPI: 1174997423
Provider Name (Legal Business Name): VALLEYVIEW INJURY & PHYSICAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE POWELL VALLEY RD SUITE 205
GRESHAM OR
97080-1494
US

IV. Provider business mailing address

2850 SE POWELL VALLEY RD SUITE 205
GRESHAM OR
97080-1494
US

V. Phone/Fax

Practice location:
  • Phone: 503-489-1998
  • Fax: 503-489-1975
Mailing address:
  • Phone: 503-489-1998
  • Fax: 503-489-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3626
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3347
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC161122
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA174721
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO19719
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4006
License Number StateOR
# 7
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number174809
License Number StateOR

VIII. Authorized Official

Name: DR. BENJAMIN LEE HEATH
Title or Position: OWNER
Credential: DC
Phone: 503-484-6128