Provider Demographics
NPI:1174785869
Name:BEAR CREEK NATUROPATHICH CLINIC
Entity type:Organization
Organization Name:BEAR CREEK NATUROPATHICH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:TICHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:541-770-5563
Mailing Address - Street 1:1012 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7027
Mailing Address - Country:US
Mailing Address - Phone:541-770-5563
Mailing Address - Fax:541-772-3028
Practice Address - Street 1:1012 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7027
Practice Address - Country:US
Practice Address - Phone:541-770-5563
Practice Address - Fax:541-772-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1324175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty