Healthcare Provider Details

I. General information

NPI: 1972758597
Provider Name (Legal Business Name): BRIAN VAITKUS N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2008
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 TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1571
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: