# LIBERTY BLANK, N.D., LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LIBERTY BLANK, N.D., LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1093594392
- **Legal business name:** LIBERTY BLANK, N.D., LLC
- **Authorized official:** LIBERTY BLANK N.D. (OWNER)
- **Authorized official phone:** (503) 944-1138

## Contact information

- **Practice address:** 15160 NW LAIDLAW ROAD, SUITE 245, PORTLAND, OR 97229
- **Practice address phone:** (503) 944-1138
- **Mailing address:** 164 NW MACLEAY BLVD, PORTLAND, OR 97210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202D00000X | Integrative Medicine Physician | — | NULL | Yes |
| 202D00000X | Integrative Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2023
- **Last updated:** 10/24/2025