PORTLAND OPTIMAL WELLNESS, LLC (NPI# 1053836247) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053836247 |
| Entity Type | Organization |
| Organization Name | PORTLAND OPTIMAL WELLNESS, LLC |
| Practice Address |
14511 Westlake Dr Ste 148 Lake Oswego OR 97035-7773 |
| Practice Telephone | 5039415351 |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2017-08-08 |
| Authorized Official Name | DR. AARON DAVISON (OWNER) |
| Authorized Official Telephone | 5036864448 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 4036 | OR | Chiropractic Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | PORTLAND OPTIMAL WELLNESS, LLC | 18840 Sw Boones Fry Rd Ste 110, Tualatin, OR 97062 |
| Street Address |
14511 WESTLAKE DR STE 148 |
| City | LAKE OSWEGO |
| State | OR |
| Zip Code | 97035-7773 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700127 | Teresa Siebenaler Scott | Social Worker | 3990 Sw Collins Way, Suite 202, Lake Owsego, OR 97035 | 2020-11-04 |
| 1528671567 | Martin Henry Lees | Internal Medicine | 14 Morningview Lane, Lake Oswego, OR 97035 | 2020-08-28 |
| 1356976187 | Premere Rehab LLC | Occupational Therapist | Infinity Rehab - The Springs At Lake Oswego, 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2020-03-12 |
| 1689212193 | Jennifer Chauvin | Nurse Practitioner | 20 Juarez Street, Lake Oswego, OR 97035 | 2019-12-16 |
| 1003396888 | Sarah Guenzburger | Physical Therapist | 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2018-08-21 |
| 1568964252 | Brett Johnson | Marriage & Family Therapist | 5655 Southwood Dr, Lake Oswego, OR 97035 | 2018-03-08 |
| 1912416561 | Michael Paul Long | Social Worker | 14523 Westlake Drive, Lake Oswego, Or 97035, Lake Oswego, OR 97035 | 2017-09-27 |
| 1467807859 | Misty Lohn | Nurse Practitioner | 5 Centerpointe Dr., Ste 600, Lake Oswego, OR 97035 | 2016-05-04 |
| 1326405473 | Kelsey Prince | Behavioral Analyst | 6400 Sw Rosewood St., Portland (lake Oswego), OR 97035 | 2016-01-20 |
| 1942683388 | Elizabeth Risberg Harrison | Massage Therapist | 190 Oswego Summit, Lake Oswego, OR 97035 | 2015-07-02 |
| Find all providers in zip 97035 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649732140 | Kelsey Marie Hudson | Chiropractor | 4000 Kruse Way Pl Ste 3-245, Lake Oswego, OR 97035-5598 | 2019-04-03 |
| 1861935124 | Haakon Kuhnle Andresen | Chiropractor | 4035 Mercantile Dr Ste 112, Lake Oswego, OR 97035-2587 | 2016-11-18 |
| 1043559867 | Larry Thomas Burks | Chiropractor | 15800 Upper Boones Ferry Rd, Suite 400, Lake Oswego, OR 97035-4085 | 2013-02-14 |
| 1841569761 | Wellness Chiropractic Center | Chiropractor | 543 Third Street, Suite A-3, Lake Oswego, OR 97034-5052 | 2011-12-21 |
| 1477849693 | Gregory Haylett Weidlich | Chiropractor | 16869 65th Ave # 356, Lake Oswego, OR 97035-7865 | 2011-06-27 |
| 1255625794 | Danielle Cornelius | Chiropractor | 15110 Boones Ferry Rd Ste 380, Lake Oswego, OR 97035-3462 | 2011-06-01 |
| 1134439409 | Jeffrey Mitchell Williams | Chiropractor | 15962 Boones Ferry Rd Ste 202, Lake Oswego, OR 97035-4360 | 2010-10-20 |
| 1265746838 | Ellen M. O'hara | Chiropractor | 4893 Parkview Dr, Ste. B, Lake Oswego, OR 97035-4490 | 2010-08-05 |
| 1871734186 | Jacque Rae Roberts | Chiropractor | 470 6th St Ste B, Lake Oswego, OR 97034-2920 | 2009-03-16 |
| 1518137553 | Davis Chiropractic | Chiropractor | 15962 Boones Ferry Rd Ste 101, Lake Oswego, OR 97035-4359 | 2008-03-05 |
| Find all providers in LAKE OSWEGO | ||||
| City | LAKE OSWEGO |
| Zip Code | 97035 |
Please comment or provide details below to improve the information on PORTLAND OPTIMAL WELLNESS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.