Provider Demographics
NPI:1063026458
Name:RANGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:RANGE CHIROPRACTIC LLC
Other - Org Name:RANGE SPORTS MEDICINE & PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DC
Authorized Official - Phone:541-290-8696
Mailing Address - Street 1:170 S 2ND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1673
Mailing Address - Country:US
Mailing Address - Phone:541-290-8696
Mailing Address - Fax:541-808-2362
Practice Address - Street 1:170 S 2ND ST STE 205
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1673
Practice Address - Country:US
Practice Address - Phone:541-290-8696
Practice Address - Fax:541-808-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty