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General NPI Number Information
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NPI Number | 1588131411
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Entity Type | Organization
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Legal Business Name | MIND & BODY WELLNESS OF BEAVERTON
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 4545 SW ANGEL AVE APT 108
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City | BEAVERTON
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State | OR
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Zip | 97005-2717
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Country | US
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Telephone | 503-891-1389
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Fax |
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Provider Business Mailing Address
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Address Line | 4545 SW ANGEL AVE APT 108
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City | BEAVERTON
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State | OR
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Zip | 97005-2717
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Country | US
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Telephone | 503-891-1389
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. CHRISTOPHER KENT STEWART
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Credential | DC
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Telephone | 503-891-1389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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