Organization
GIFT OF LIFE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIA CRUPPER N.D., L.M.T (CO-OWNER, NATUROPATHIC DOCTOR)
(503) 235-2259
Entity
Organization
Contact information
Practice address
4259 NE BROADWAY ST, PORTLAND, OR 97213-1421
(503) 235-2259
Mailing address
4259 NE BROADWAY ST, PORTLAND, OR 97213-1421
(503) 235-2259
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
7621
OR
175F00000X
Naturopath
Primary
1481 & 1618
OR
176B00000X
Midwife
84-OB
OR
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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