Provider Demographics
NPI:1962612200
Name:NATIONAL COLLEGE OF NATURAL MEDICINE
Entity type:Organization
Organization Name:NATIONAL COLLEGE OF NATURAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO AND DEAN OF CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:IDA
Authorized Official - Last Name:DEHEN
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:503-552-1551
Mailing Address - Street 1:049 SW PORTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4848
Mailing Address - Country:US
Mailing Address - Phone:503-552-1551
Mailing Address - Fax:503-295-3609
Practice Address - Street 1:2232 NW PETTYGROVE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2608
Practice Address - Country:US
Practice Address - Phone:503-552-1552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137646Medicaid
OR025087000OtherBLUE CROSS BLUE SHIELD #