Provider Demographics
NPI:1548632532
Name:NORTHWEST INTEGRATIVE MEDICINE, PC
Entity type:Organization
Organization Name:NORTHWEST INTEGRATIVE MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAEGHAN
Authorized Official - Middle Name:CULVER
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-855-4341
Mailing Address - Street 1:15875 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7913
Mailing Address - Country:US
Mailing Address - Phone:971-252-8459
Mailing Address - Fax:
Practice Address - Street 1:19365 SW 65TH AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9196
Practice Address - Country:US
Practice Address - Phone:503-765-6020
Practice Address - Fax:504-741-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3005175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty