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Chiropractic Providers Chiropractor Neurology

Provider NPI: 1699815647

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
7100 SW HAMPTON ST STE 121A TIGARD, OR 97223-8390 US
Tel: 503-855-4465  Fax: 888-201-5353

Business Mailing Address:
PO BOX 2415  WILSONVILLE, OR 97070-2415 US
Tel: 503-855-4465  Fax: 888-201-5353

NPI Information:
NPI: 1699815647
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y111NN0400XChiropractic Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 111NN0400X





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