Provider Demographics
NPI:1003423914
Name:EVERGREEN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:EVERGREEN CHIROPRACTIC PC
Other - Org Name:EVERGREEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:MANNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-912-1156
Mailing Address - Street 1:5920 BURMA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3240
Mailing Address - Country:US
Mailing Address - Phone:971-330-8017
Mailing Address - Fax:
Practice Address - Street 1:657 NE HOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7328
Practice Address - Country:US
Practice Address - Phone:503-912-1156
Practice Address - Fax:971-292-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty