Organization
BLUE AUTUMN BALANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEVERLY KI HACELY N.D., L.AC. (OWNER)
(503) 583-3235
Entity
Organization
Contact information
Practice address
10200 SW EASTRIDGE ST, #135, PORTLAND, OR 97225-5064
(503) 583-3235
Mailing address
2850 SW CEDAR HILLS BLVD, #254, BEAVERTON, OR 97005-1354
(503) 583-3235
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
1279
OR
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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