Provider Demographics
NPI:1306479597
Name:BON VIVANT HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:BON VIVANT HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SPIEGELBERG
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS
Authorized Official - Phone:971-238-1968
Mailing Address - Street 1:7522 SW ALOMA WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7927
Mailing Address - Country:US
Mailing Address - Phone:704-904-8288
Mailing Address - Fax:
Practice Address - Street 1:7000 SW HAMPTON ST STE 130
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8374
Practice Address - Country:US
Practice Address - Phone:971-258-1968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty