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General NPI Number Information
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NPI Number | 1164715504
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Entity Type | Organization
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Legal Business Name | BLOOM NATURAL HEALTHCARE
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 125 NE KILLINGSWORTH ST STE 101
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City | PORTLAND
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State | OR
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Zip | 97211-2664
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Country | US
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Telephone | 503-223-3741
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Fax |
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Provider Business Mailing Address
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Address Line | 125 NE KILLINGSWORTH ST STE 101
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City | PORTLAND
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State | OR
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Zip | 97211-2664
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOLLY HAYMAN O'NEILL
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Credential |
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Telephone | 503-223-2741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01051
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 1526
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License Number State | OR
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