# MEDIPRO DIRECT SLIM, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** MediPro Holistic Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457692444
- **Authorized official:** MRS. KELLY KYSER (OFFICE MANAGER)
- **Authorized official phone:** (503) 828-9265

## Contact information

- **Practice address:** 17933 NW EVERGREEN PKWY, SUITE 220, BEAVERTON, OR 97006-7659
- **Practice address phone:** (503) 828-9265
- **Practice address fax:** (503) 828-9054
- **Mailing address:** 17933 NW EVERGREEN PKWY STE 285, BEAVERTON, OR 97006-7513
- **Mailing address phone:** (503) 828-9265
- **Mailing address fax:** (503) 303-8997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 133N00000X | Nutritionist | — | NULL | — |
| 133N00000X | Nutritionist | — | — | — |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 175F00000X | Naturopath | 1430 | OR | — |
| 175F00000X | Naturopath | — | NULL | — |
| 175F00000X | Naturopath | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/15/2013
- **Last updated:** 10/26/2022