Organization
HEALTHSOURCE OF SE PORTLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KIMMI (CLINIC DIRECTOR)
(503) 641-4244
Entity
Organization
Contact information
Practice address
5424 SE 82ND AVE, PORTLAND, OR 97266-4811
(503) 774-1252
(503) 774-1271
Mailing address
5424 SE 82ND AVE, PORTLAND, OR 97266-4811
(503) 774-1252
(503) 774-1271
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
12/18/2013
Last updated
12/18/2013
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