Provider Demographics
NPI:1033547732
Name:DASHIELL, ALLIE RENE (DC, MS)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:RENE
Last Name:DASHIELL
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 N VANCOUVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2826
Mailing Address - Country:US
Mailing Address - Phone:503-493-9398
Mailing Address - Fax:503-493-9518
Practice Address - Street 1:4922 N VANCOUVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2826
Practice Address - Country:US
Practice Address - Phone:503-493-9398
Practice Address - Fax:503-493-9518
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor