Organization
EVERGREEN INTEGRATIVE MEDICINE, LLC
Active
Other names
NW Functional Thyroid Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN SCOTT SOSZKA ND, LAC (MEMBER/MANAGER)
(503) 388-6715
Entity
Organization
Contact information
Practice address
4926 SE WOODSTOCK BLVD, PORTLAND, OR 97206-6163
(503) 388-6715
(888) 302-5652
Mailing address
4926 SE WOODSTOCK BLVD, PORTLAND, OR 97206-6163
(503) 388-6715
(888) 302-5652
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
1333
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275019
—
OR
Enumeration date
06/17/2015
Last updated
03/24/2022
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