Provider Demographics
NPI:1386953578
Name:MALUS, HENRY A (ND)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:MALUS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:TINEKE
Other - Middle Name:
Other - Last Name:MALUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2829
Mailing Address - Country:US
Mailing Address - Phone:503-239-8181
Mailing Address - Fax:503-548-4013
Practice Address - Street 1:314 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2829
Practice Address - Country:US
Practice Address - Phone:503-239-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA794172P00000X
UT291919-7100175F00000X
OR1755175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No172P00000XOther Service ProvidersNaprapath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500636547Medicaid