Healthcare Provider Details

I. General information

NPI: 1760667083
Provider Name (Legal Business Name): JESSE IAN BUTTLER N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 01/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SE WASHINGTON ST STE 104
MILWAUKIE OR
97222-7647
US

IV. Provider business mailing address

2305 SE WASHINGTON ST STE 104
MILWAUKIE OR
97222-7647
US

V. Phone/Fax

Practice location:
  • Phone: 503-786-2181
  • Fax: 503-200-2259
Mailing address:
  • Phone: 503-786-2181
  • Fax: 503-200-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1592
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: