Provider Demographics
NPI:1124371836
Name:PALACIOS, DAVID ALFONSO (ND)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALFONSO
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 SW STREAMSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8954
Mailing Address - Country:US
Mailing Address - Phone:831-227-5192
Mailing Address - Fax:
Practice Address - Street 1:11830 KERR PKWY STE 208
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1228
Practice Address - Country:US
Practice Address - Phone:503-334-2312
Practice Address - Fax:971-255-1900
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1900175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath