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Organization
WATERSHED COMMUNITY WELLNESS LLC
Active
Organization
WATERSHED COMMUNITY WELLNESS LLC
Active
Other names
Watershed Community Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC BENJAMIN GREY LAC (MEMBER)
(503) 820-8040
Entity
Organization
Contact information
Practice address
1988 SE LADD AVE, PORTLAND, OR 97214-4737
(503) 820-8040
(503) 564-0180
Mailing address
1988 SE LADD AVE, PORTLAND, OR 97214-4737
(503) 820-8040
(503) 564-0180
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC150225
OR
172M00000X
Mechanotherapist
12190
OR
Other
Enumeration date
11/12/2009
Last updated
01/20/2011
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