Wild Mountain Medicine LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

Legal business name

WILD MOUNTAIN MEDICINE LLC

Practice address

3863 SW Hall Blvd Ste B
Beaverton, OR 97005-2042

Phone

(541) 944-1989

NPI assigned

Nov 15, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Madeline ChavezNPI 1710305784

Title

Owner

Phone

(541) 944-1989

Specialties & licenses 1

Addresses

Other names 1

• Wild Mountain Medicine Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Madeline Leslie Chavez, LMT

  • Massage Therapist
  • Beaverton, OR
  • NPI 1710305784
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636934400000",
    "number": "1144986068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3863 SW HALL BLVD STE B",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052042",
            "telephone_number": "541-944-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3863 SW HALL BLVD STE B",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052042",
            "telephone_number": "541-944-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD MOUNTAIN MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-15",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "MADELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-944-1989"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wild Mountain Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Donna Christine Wicher, PH.D.
• Casandra Wienekepainchaud
• Kristen Wiidanen
• Laura Nicole Wilbourn, CNM
• Payton Wilcox
• Wild Wish Counseling LLC
• Jonathan Douglas Wildi, M.D.
• Wildwood Health and Wellness
• Wildwood Psychiatric Resource Center
• Suzanne Wilhour

• Acupuncturist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.