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Chiropractic Providers Chiropractor

Provider NPI: 1003132408

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 503-225-9033  Fax: 503-225-9039

Business Mailing Address:
Tel: 503-225-9033  Fax: 503-225-9039

NPI Information:
NPI: 1003132408
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
N111NN0400XChiropractic Providers
N111NN1001XChiropractic Providers
N111NP0017XChiropractic Providers
N111NR0200XChiropractic Providers
N111NR0400XChiropractic Providers
N111NS0005XChiropractic Providers
N111NX0800XChiropractic Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 111N00000X





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