Provider Demographics
NPI:1285994269
Name:BAMBU CLINIC, LLC
Entity type:Organization
Organization Name:BAMBU CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISKO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-274-9360
Mailing Address - Street 1:2240 N INTERSTATE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1771
Mailing Address - Country:US
Mailing Address - Phone:503-274-9360
Mailing Address - Fax:503-274-9370
Practice Address - Street 1:2256 N ALBINA AVE STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1774
Practice Address - Country:US
Practice Address - Phone:503-274-9360
Practice Address - Fax:503-274-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1318175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty