Provider Demographics
NPI:1073526620
Name:BREITENSTEIN, ROBERT WILLIAM JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:BREITENSTEIN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BREITENSTEIN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:8070 SW HALL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6419
Mailing Address - Country:US
Mailing Address - Phone:503-643-0156
Mailing Address - Fax:971-732-5624
Practice Address - Street 1:8070 SW HALL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6419
Practice Address - Country:US
Practice Address - Phone:503-643-0156
Practice Address - Fax:971-732-5624
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor