1801115019 NPI number — PIONEER CHIROPRACTIC AND WELLNESS

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 1801115019 NPI number — PIONEER CHIROPRACTIC AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIONEER CHIROPRACTIC AND WELLNESS
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:
1801115019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 SW MORRISON ST
Provider Second Line Business Mailing Address:
SUITE 912
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97205-3122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-488-5485
Provider Business Mailing Address Fax Number:
503-488-5834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 SW MORRISON ST
Provider Second Line Business Practice Location Address:
SUITE 912
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-3122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-488-5485
Provider Business Practice Location Address Fax Number:
503-488-5834
Provider Enumeration Date:
05/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCBRIDE
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
RYAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-488-5485

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  731371 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 603007695 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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