1871670588 NPI number — RICHARD O BROUSE DC CLN

Table of content: RICHARD O BROUSE DC CLN (NPI 1871670588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871670588 NPI number — RICHARD O BROUSE DC CLN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROUSE
Provider First Name:
RICHARD
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC CLN
Provider Gender Code:
M

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:
1871670588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8800 SE SUNNYSIDE RD
Provider Second Line Business Mailing Address:
#111
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-654-3225
Provider Business Mailing Address Fax Number:
503-654-3056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
#111
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-654-3225
Provider Business Practice Location Address Fax Number:
503-654-3056
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  271359 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 133N00000X , with the licence number: 10333348 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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