Provider Demographics
NPI:1073674289
Name:MCDONOUGH, COLLEEN BRIDGET (DC)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:BRIDGET
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SUPERIOR ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5170
Mailing Address - Country:US
Mailing Address - Phone:503-485-0830
Mailing Address - Fax:503-485-0831
Practice Address - Street 1:358 SUPERIOR ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5170
Practice Address - Country:US
Practice Address - Phone:503-485-0830
Practice Address - Fax:503-485-0831
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272948111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation