Healthcare Provider Details

I. General information

NPI: 1144683160
Provider Name (Legal Business Name): ALBERTA HEALING ARTS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6533 NE SANDY BLVD
PORTLAND OR
97213-4569
US

IV. Provider business mailing address

6533 NE SANDY BLVD
PORTLAND OR
97213-4569
US

V. Phone/Fax

Practice location:
  • Phone: 503-206-5309
  • Fax: 503-914-0459
Mailing address:
  • Phone: 503-206-5309
  • Fax: 503-914-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01094
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1571
License Number StateOR

VIII. Authorized Official

Name: DR. BRIAN VAITKUS
Title or Position: CMO
Credential: ND
Phone: 503-206-5309