Organization
ORIGINS FUNCTIONAL WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN KAY GRIFFIN (CONTRACTING)
(541) 890-1602
Entity
Organization
Contact information
Practice address
675 N 5TH ST, JACKSONVILLE, OR 97530-9659
(432) 638-5747
Mailing address
125 PONDEROSA WAY, JACKSONVILLE, OR 97530-9018
(432) 638-5747
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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