Provider Demographics
NPI:1033377379
Name:T V HIGHWAY CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:T V HIGHWAY CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-642-3018
Mailing Address - Street 1:18055 SW TV HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3953
Mailing Address - Country:US
Mailing Address - Phone:503-642-3018
Mailing Address - Fax:503-591-9334
Practice Address - Street 1:18055 SW TV HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3953
Practice Address - Country:US
Practice Address - Phone:503-642-3018
Practice Address - Fax:503-591-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2433261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGFLPMedicare PIN