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General NPI Number Information
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NPI Number | 1568632180
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Entity Type | Organization
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Legal Business Name | SAMARITAN INTEGRATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 990 NW CIRCLE BOULEVARD
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City | CORVALLIS
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State | OR
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Zip | 97330-1410
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Country | US
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Telephone | 541-768-6412
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Fax | 541-768-6643
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Provider Business Mailing Address
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Address Line | 815 NW 9TH STREET SUITE 259
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City | CORVALLIS
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State | OR
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Zip | 97330-6173
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Country | US
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Telephone | 541-768-6768
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Fax | 541-768-6774
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Authorized Official
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Title or Position | CEO
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Name | MR. STEVEN W JASPERSON
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Credential |
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Telephone | 541-768-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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