1609321157 NPI number — CONERSTONE CHIROPRACTIC PS INC

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 1609321157 NPI number — CONERSTONE CHIROPRACTIC PS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONERSTONE CHIROPRACTIC PS INC
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:
OREGON CS CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1609321157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4655 SW GRIFFITH DR
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97005-8728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-746-5214
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4655 SW GRIFFITH DR
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005-8728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-746-5214
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
YOUNGYUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-746-5214

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  5621 , 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)





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