Origins Functional Wellness, LLC

NPI #1306326913 in Jacksonville, Oregon

Provider Information

NPI Number: 1306326913
Entity Type: Organization
Organization Name: Origins Functional Wellness, LLC
Primary Specialty: Family Medicine
Enumeration Date: Aug 14, 2018
Last Updated: Aug 14, 2018

Practice Location

Address: 675 N 5TH ST
City: Jacksonville
State: Oregon
ZIP Code: 97530-9659
Phone: (432) 638-5747

Authorized Official

Name: KATHLEEN KAY GRIFFIN
Title: CONTRACTING
Phone: (541) 890-1602

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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