Healthcare Provider Details

I. General information

NPI: 1215115241
Provider Name (Legal Business Name): ELIZABETH BUSETTO ND, DC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38706 PIONEER BLVD
SANDY OR
97055-8008
US

IV. Provider business mailing address

38706 PIONEER BLVD STE 240
SANDY OR
97055-8008
US

V. Phone/Fax

Practice location:
  • Phone: 503-954-3676
  • Fax: 503-994-0294
Mailing address:
  • Phone: 503-954-3676
  • Fax: 503-994-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5521
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-89121
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1585
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: