Basic Information
| Provider Information | |||||||||
| NPI: | 1922372085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEIGH K LEWIS ND LAC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 NW FLANDERS ST | ||||||||
| Address2: | #205 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972103443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032274050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 NW FLANDERS ST | ||||||||
| Address2: | #205 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972103443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032274050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2012 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | LEIGH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | NATUROPATHIC PHYSICIAN/ACUPUNCTURIS | ||||||||
| AuthorizedOfficialTelephone: | 5032274050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | ND, LAC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC00771 | OR | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist | 175F00000X | 1292 | OR | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Naturopath |
No ID Information.