Provider Demographics
NPI:1033262142
Name:CHIROPRACTIC PHYSICIANS, PC
Entity Type:Organization
Organization Name:CHIROPRACTIC PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-378-0068
Mailing Address - Street 1:705 EWALD AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3403
Mailing Address - Country:US
Mailing Address - Phone:503-378-0068
Mailing Address - Fax:503-378-0069
Practice Address - Street 1:705 EWALD AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3403
Practice Address - Country:US
Practice Address - Phone:503-378-0068
Practice Address - Fax:503-378-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORX04233Medicare UPIN
OR0000WFBMQMedicare ID - Type Unspecified