Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 272272 | OR |
N | 111NN1001X | Nutrition | 272272 | OR |
N | 111NR0400X | Rehabilitation Chiropractor | 272272 | OR |
NPI | 1457568958 |
---|---|
Provider Name | Dr. Athena Paradise |
First Address | Portland, OR 97214-1531 |
Second Address | Portland, OR 97214-1531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |