Provider Demographics
NPI:1174062202
Name:SOUTHERN OREGON TRUE HEALTH LLC
Entity type:Organization
Organization Name:SOUTHERN OREGON TRUE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-309-2207
Mailing Address - Street 1:635 LIT WAY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2414
Mailing Address - Country:US
Mailing Address - Phone:208-309-2207
Mailing Address - Fax:541-804-7710
Practice Address - Street 1:635 LIT WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2414
Practice Address - Country:US
Practice Address - Phone:208-309-2207
Practice Address - Fax:541-804-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty