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General NPI Number Information
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NPI Number | 1407249659
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Entity Type | Organization
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Legal Business Name | NEW LEAF HEALTH CLINIC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 14900 SW BARROWS RD BUILDING B, SUITE 201
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City | BEAVERTON
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State | OR
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Zip | 97007-7524
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Country | US
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Telephone | 971-533-1700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 96173
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City | PORTLAND
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State | OR
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Zip | 97296-6003
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Country | US
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Telephone | 971-533-1700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN LUCHS
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Credential | ND, LAC
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Telephone | 971-533-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1817
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License Number State | OR
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