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General NPI Number Information
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NPI Number | 1619322641
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Entity Type | Organization
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Legal Business Name | SELAH NATURAL MEDICINE
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 8375 SW BEAVERTON HILLSDALE HWY SUITE C
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City | PORTLAND
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State | OR
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Zip | 97225-2252
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Country | US
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Telephone | 503-206-6996
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Fax | 888-959-9018
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Provider Business Mailing Address
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Address Line | 8375 SW BEAVERTON HILLSDALE HWY SUITE C
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City | PORTLAND
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State | OR
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Zip | 97225-2252
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Country | US
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Telephone | 503-206-6996
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Fax | 888-959-9018
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Authorized Official
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Title or Position | NATUROPATHIC PHYSICIAN
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Name | DR. MARLEN IRVIN CHIP HALVERSON
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Credential | N.D.
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Telephone | 503-206-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 1885
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License Number State | OR
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