Healthcare Provider Details

I. General information

NPI: 1619627759
Provider Name (Legal Business Name): SAMI LEE EBNER DC, ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 SE 12TH AVE
PORTLAND OR
97214-1323
US

IV. Provider business mailing address

436 SE 12TH AVE
PORTLAND OR
97214-1323
US

V. Phone/Fax

Practice location:
  • Phone: 971-359-0012
  • Fax: 971-484-1992
Mailing address:
  • Phone: 971-359-0012
  • Fax: 971-484-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number5133
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6224
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: