Provider Demographics
NPI:1780026401
Name:RESTORATIVE HEALTH CLINIC
Entity type:Organization
Organization Name:RESTORATIVE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WERNER
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSLOO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-747-2021
Mailing Address - Street 1:17685 SW 65TH AVE. SUITE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-747-2021
Mailing Address - Fax:503-747-2802
Practice Address - Street 1:17685 SW 65TH AVE. SUITE 300
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-747-2021
Practice Address - Fax:503-747-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1300004523175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1922027770OtherNPI
OR1033314679OtherNPI
OR1487905428OtherNPI