Provider Demographics
NPI:1194979252
Name:PORTLAND ALTERNATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:PORTLAND ALTERNATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODSDON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-267-7460
Mailing Address - Street 1:4425 SW CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4260
Mailing Address - Country:US
Mailing Address - Phone:010-109-3425
Mailing Address - Fax:010-109-3425
Practice Address - Street 1:4425 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4260
Practice Address - Country:US
Practice Address - Phone:010-109-3425
Practice Address - Fax:010-109-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center