Provider Demographics
NPI:1548832736
Name:WILSONVILLE NATURAL MEDICINE, LLC
Entity type:Organization
Organization Name:WILSONVILLE NATURAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:SCHMALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:ND, DC
Authorized Official - Phone:503-855-3244
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-2086
Mailing Address - Country:US
Mailing Address - Phone:503-855-3244
Mailing Address - Fax:503-855-3597
Practice Address - Street 1:8855 SW HOLLY LN STE 105
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8792
Practice Address - Country:US
Practice Address - Phone:503-855-3244
Practice Address - Fax:503-855-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCM00126432OtherMALPRACTICE POLICY NUMBER