1518137553 NPI number — DAVIS CHIROPRACTIC

Table of content: (NPI 1518137553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518137553 NPI number — DAVIS CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVIS CHIROPRACTIC
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:
1518137553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19901
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97280-0901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-764-7847
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15962 BOONES FERRY RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97035-4359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-699-9299
Provider Business Practice Location Address Fax Number:
503-699-0718
Provider Enumeration Date:
03/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
DR.
Authorized Official Telephone Number:
503-764-7847

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3487 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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