Healthcare Provider Details

I. General information

NPI: 1528237484
Provider Name (Legal Business Name): URBAN WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SE DIVISION ST
PORTLAND OR
97206-1544
US

IV. Provider business mailing address

4900 SE DIVISION ST
PORTLAND OR
97206-1544
US

V. Phone/Fax

Practice location:
  • Phone: 503-445-9771
  • Fax: 503-445-9772
Mailing address:
  • Phone: 503-445-9771
  • Fax: 503-445-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1547
License Number StateOR

VIII. Authorized Official

Name: DR. JASON ERIC ZABELL
Title or Position: CLINIC DIRECTOR/OWNER
Credential: ND
Phone: 503-445-9771