Mackenzie Anne Champ, N.D., LA.C
Individual provider Active NPI Naturopath · Nehalem, OR
NPI 1588090856 · NPPES record last updated Jan 23, 2015
Key facts
- NPI
- 1588090856
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Naturopath 175F00000X
- License
- 2005 (OR)
- Practice address
- 35890 Highway 101 N
Nehalem, OR 97131-9599 - Phone
- (503) 368-4312
- Fax
- (503) 368-4315
- NPI assigned
- Sep 18, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005 | OR | MD | Clinical Psychologist |
| 156719 | OR | MD | Acupuncturist |
| 14010 | OR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish Natural Family Medicine | Acupuncturist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 156719 | OR | |
| Reflexologist | 173C00000X | 14010 | OR | |
| Naturopath | 175F00000X | 2005 | OR | Yes |
Addresses
Primary practice location
35890 Highway 101 N
Nehalem, OR 97131-9599
Mailing address
PO Box 504
Nehalem, OR 97131-0504
Phone (503) 368-4312
Other providers in Nehalem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.