Healthcare Provider Details

I. General information

NPI: 1083552012
Provider Name (Legal Business Name): ORIGINS INTEGRATIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1421 SE ANKENY ST
PORTLAND OR
97214-1471
US

IV. Provider business mailing address

1421 SE ANKENY ST
PORTLAND OR
97214-1471
US

V. Phone/Fax

Practice location:
  • Phone: 971-219-9806
  • Fax:
Mailing address:
  • Phone: 971-219-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CASEY MCGUIRE
Title or Position: DIRECTOR OF OPERATIONS
Credential: LAC
Phone: 971-219-9806