Provider Demographics
NPI:1063088128
Name:RENEW FUNCTIONAL HEALTH
Entity type:Organization
Organization Name:RENEW FUNCTIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-709-4237
Mailing Address - Street 1:16331 SE VINEYARD LN APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4722
Mailing Address - Country:US
Mailing Address - Phone:503-709-4237
Mailing Address - Fax:971-228-5443
Practice Address - Street 1:14631 SW MILLIKAN WAY STE 4
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2999
Practice Address - Country:US
Practice Address - Phone:503-567-7890
Practice Address - Fax:971-228-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty