Organization
WATERSHED COMMUNITY WELLNESS LLC
Active
Other names
Watershed Community Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC BENJAMIN GREY LAC (MEMBER)
(503) 820-8040
Entity
Organization
Contact information
Practice address
1988 SE LADD AVE, PORTLAND, OR 97214-4737
(503) 820-8040
(503) 564-0180
Mailing address
1988 SE LADD AVE, PORTLAND, OR 97214-4737
(503) 820-8040
(503) 564-0180
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC150225
OR
172M00000X
Mechanotherapist
12190
OR
Other
Enumeration date
11/12/2009
Last updated
01/20/2011
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