Organization
TIGARD HOLISTIC HEALTH CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY LYNN RAFFETY ND (OWNER)
(503) 639-1712
Entity
Organization
Contact information
Practice address
11930 SW GREENBURG RD, TIGARD, OR 97223-6453
(503) 639-1712
Mailing address
11930 SW GREENBURG RD, TIGARD, OR 97223-6453
(503) 639-1712
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0855
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003861493
NATUROPATHIC
OR
Enumeration date
05/10/2012
Last updated
05/10/2012
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