# HEALTHSOURCE OF SE PORTLAND

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659792620
- **Authorized official:** EDWARD KIMMI (CLINIC DIRECTOR)
- **Authorized official phone:** (503) 641-4244

## Contact information

- **Practice address:** 5424 SE 82ND AVE, PORTLAND, OR 97266-4811
- **Practice address phone:** (503) 774-1252
- **Practice address fax:** (503) 774-1271
- **Mailing address:** 5424 SE 82ND AVE, PORTLAND, OR 97266-4811
- **Mailing address phone:** (503) 774-1252
- **Mailing address fax:** (503) 774-1271

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | Yes |
| 111N00000X | Chiropractor | — | — | Yes |

## Other

- **Enumeration date:** 12/18/2013
- **Last updated:** 12/18/2013