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NPI Code Detail

MEDICARE: PURELY HEALTH CLINIC, LLC

MEDICARE: PURELY HEALTH CLINIC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175F00000XNaturopath2045OR

General Provider Information

NPI Number : 1831592823
Entity Type Code : Organization
Provider Name (Legal Business Name) : PURELY HEALTH CLINIC, LLC
Provider Business Mailing Address
First Line : 5800 SW TERWILLIGER BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-2882
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1305 NE FREMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-2218
Country : US
Telephone Number : 860-614-4878
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : JOHN BEEDENBENDER
Credential : ND
Telephone Number : 860-614-4878
Provider Enumeration Date : 10/03/2014
Last Update Date : 10/03/2014

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Directions to “PURELY HEALTH CLINIC, LLC ” Practice Location

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