Provider Demographics
NPI:1487775656
Name:STARGROVE, MITCHELL BEBEL (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:BEBEL
Last Name:STARGROVE
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 SW WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0511
Mailing Address - Country:US
Mailing Address - Phone:503-526-0397
Mailing Address - Fax:503-643-4633
Practice Address - Street 1:4720 SW WATSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0511
Practice Address - Country:US
Practice Address - Phone:503-526-0397
Practice Address - Fax:503-643-4633
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR95171100000X
OR696175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath