Provider Demographics
NPI:1043572852
Name:HEART SPRING HEALTH LLC
Entity type:Organization
Organization Name:HEART SPRING HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERRON
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILKIE
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:503-956-9396
Mailing Address - Street 1:7886 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-956-9396
Mailing Address - Fax:503-206-4791
Practice Address - Street 1:7886 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-956-9396
Practice Address - Fax:503-206-4791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART SPRING HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-08
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500773243Medicaid
OR1851625560OtherNPI