# EASTSIDE WELLNESS CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Element Wellness and Sports Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053504696
- **Authorized official:** DR. NOAH I GOODWILL D.C. (OWNER)
- **Authorized official phone:** (503) 445-7999

## Contact information

- **Practice address:** 5331 SW MACADAM AVE, SUITE 105, PORTLAND, OR 97239-6104
- **Practice address phone:** (503) 445-7999
- **Practice address fax:** (503) 445-7997
- **Mailing address:** 5331 SW MACADAM AVE, SUITE 105, PORTLAND, OR 97239-6104
- **Mailing address phone:** (503) 445-7999
- **Mailing address fax:** (503) 445-7997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 3372 | OR | Yes |
| 225100000X | Physical Therapist | 3758 | OR | — |

## Other

- **Enumeration date:** 08/27/2007
- **Last updated:** 12/13/2012