Provider Demographics
NPI:1194156448
Name:CENTER FOR TRADITIONAL MEDICINE, P.C.
Entity type:Organization
Organization Name:CENTER FOR TRADITIONAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-636-2734
Mailing Address - Street 1:320 OSWEGO POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3228
Mailing Address - Country:US
Mailing Address - Phone:503-636-2734
Mailing Address - Fax:503-636-3250
Practice Address - Street 1:320 OSWEGO POINTE DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3228
Practice Address - Country:US
Practice Address - Phone:503-636-2734
Practice Address - Fax:503-636-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty