Healthcare Provider Details

I. General information

NPI: 1013289321
Provider Name (Legal Business Name): HERDENER FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NE EVANS ST
MCMINNVILLE OR
97128-4605
US

IV. Provider business mailing address

340 NE EVANS ST
MCMINNVILLE OR
97128-4605
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-6170
  • Fax:
Mailing address:
  • Phone: 503-434-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number579
License Number State

VIII. Authorized Official

Name: DR. LARRY JOSEPH HERDENER
Title or Position: OWNER/NATUROPATHIC PHYSICIAN
Credential: ND
Phone: 503-434-6170