Healthcare Provider Details

I. General information

NPI: 1841253457
Provider Name (Legal Business Name): 2BWELL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 NW 9TH AVE SUITE 113
PORTLAND OR
97209
US

IV. Provider business mailing address

1255 NW 9TH AVE SUITE 113
PORTLAND OR
97209
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-0044
  • Fax: 503-515-8099
Mailing address:
  • Phone: 503-655-0044
  • Fax: 503-515-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00307
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00558
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1458
License Number StateOR

VIII. Authorized Official

Name: SIAMAK F. SHIRAZZI
Title or Position: FOUNDER/DIRECTOR
Credential: LAC, DOM
Phone: 503-655-0044