1174564934 NPI number — MILWAUKIE CHIROPRACTIC CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174564934 NPI number — MILWAUKIE CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILWAUKIE CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174564934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3716 SE INTERNATIONAL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKIE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-659-0073
Provider Business Mailing Address Fax Number:
503-659-7471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3716 SE INTERNATIONAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-659-0073
Provider Business Practice Location Address Fax Number:
503-659-7471
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNS
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-659-0073

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 825279001 . This is a "REGENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370939 . This is a "AMERICAN SPECIALTY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 117094 . This is a "KAISER PERMANENTE PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30176 . This is a "WASHINGTON DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 825279000 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85120066620630 . This is a "REGENCE LIFE & HEALTH" identifier . This identifiers is of the category "OTHER".




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