Organization
MEDIPRO DIRECT SLIM, LLC
Active
Other names
MediPro Holistic Health
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY KYSER (OFFICE MANAGER)
(503) 828-9265
Entity
Organization
Contact information
Practice address
17933 NW EVERGREEN PKWY, SUITE 220, BEAVERTON, OR 97006-7659
(503) 828-9265
(503) 828-9054
Mailing address
17933 NW EVERGREEN PKWY STE 285, BEAVERTON, OR 97006-7513
(503) 828-9265
(503) 303-8997
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
133N00000X
Nutritionist
—
—
171100000X
Acupuncturist
—
—
175F00000X
Naturopath
1430
OR
175F00000X
Naturopath
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/15/2013
Last updated
10/26/2022
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