1699005884 NPI number — CORNELIUS CHIROPRACTIC LLC

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 1699005884 NPI number — CORNELIUS CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNELIUS CHIROPRACTIC LLC
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 SPINE AND DISC
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:
1699005884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5035 NE ELAM YOUNG PKWY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97124-6425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-626-3700
Provider Business Mailing Address Fax Number:
503-643-6667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5035 NE ELAM YOUNG PKWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97124-6425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-626-3700
Provider Business Practice Location Address Fax Number:
503-643-6667
Provider Enumeration Date:
01/11/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMLIN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
JACK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-626-3700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3980 , 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)