Healthcare Provider Details

I. General information

NPI: 1346315801
Provider Name (Legal Business Name): J BLACK NO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 NE MCDANIEL LANE
MCMINNVILLE OR
97128
US

IV. Provider business mailing address

2270 NE MCDANIEL LANE
MCMINNVILLE OR
97128
US

V. Phone/Fax

Practice location:
  • Phone: 503-883-0333
  • Fax: 503-883-0330
Mailing address:
  • Phone: 503-883-0333
  • Fax: 503-883-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1269
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1263
License Number StateOR

VIII. Authorized Official

Name: DR. JESSICA BLACK
Title or Position: OWNER NATUROPATHIC PHYSICIAN
Credential: NO
Phone: 503-883-0333