Provider Demographics
NPI:1073656831
Name:HUNTLEY, NORBERT EDWIN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:NORBERT
Middle Name:EDWIN ANDREW
Last Name:HUNTLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 SE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4927
Mailing Address - Country:US
Mailing Address - Phone:503-771-2848
Mailing Address - Fax:503-257-5055
Practice Address - Street 1:10011 SE DIVISION ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1351
Practice Address - Country:US
Practice Address - Phone:503-257-5900
Practice Address - Fax:503-257-5055
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272417111N00000X
CA19162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGFDMMedicare ID - Type UnspecifiedCHIROPRACTOR MEDICARE