Organization
FERTILE GROUND FAMILY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROLINE PETERSON DC, PHD, MPH, LDM (DIRECTOR)
(503) 284-6195
Entity
Organization
Contact information
Practice address
3575 NE BROADWAY ST, PORTLAND, OR 97232-1820
(503) 284-6195
Mailing address
3575 NE BROADWAY ST, PORTLAND, OR 97232-1820
(503) 284-6195
Taxonomy
Speciality
Code
Description
License number
State
261QB0400X
Birthing Clinic/Center
DEM-LD-10144749
OR
261QP2300X
Primary Care Clinic/Center
Primary
2921
OR
Other
Enumeration date
12/13/2012
Last updated
12/13/2012
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