Healthcare Provider Details

I. General information

NPI: 1841400850
Provider Name (Legal Business Name): ALLBUTTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SW TAYLOR ST #330
PORTLAND OR
97205-2543
US

IV. Provider business mailing address

7928 SE MADISON ST
PORTLAND OR
97215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 503-754-6136
  • Fax: 503-221-5454
Mailing address:
  • Phone: 503-754-6136
  • Fax: 503-221-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number3117
License Number StateOR

VIII. Authorized Official

Name: DR. DAVID B RUSS
Title or Position: OWNER
Credential: DC
Phone: 503-754-6136