Provider Demographics
NPI:1023386851
Name:CAPONE, RAYMOND ANTHONY III (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:CAPONE
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22020 NE CHINOOK WAY
Mailing Address - Street 2:APT B
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-2701
Mailing Address - Country:US
Mailing Address - Phone:412-389-7811
Mailing Address - Fax:
Practice Address - Street 1:2031 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1649
Practice Address - Country:US
Practice Address - Phone:503-224-2100
Practice Address - Fax:503-224-2129
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor