Healthcare Provider Details

I. General information

NPI: 1083300628
Provider Name (Legal Business Name): OREGON TRAIL INTEGRATIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 STRAUSS AVE
SANDY OR
97055-8060
US

IV. Provider business mailing address

PO BOX 909
BORING OR
97009-0909
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5822
  • Fax: 503-668-3662
Mailing address:
  • Phone: 503-668-5822
  • Fax: 503-668-3662

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: DR. JONATHAN CLIFTON RHUE
Title or Position: OWNER
Credential: DC
Phone: 503-201-7532