Provider Demographics
NPI:1073965257
Name:OPEN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:OPEN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-222-3000
Mailing Address - Street 1:2100 NE BROADWAY ST
Mailing Address - Street 2:STE 225
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1569
Mailing Address - Country:US
Mailing Address - Phone:503-222-3000
Mailing Address - Fax:971-255-1754
Practice Address - Street 1:2100 NE BROADWAY ST
Practice Address - Street 2:STE 225
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1569
Practice Address - Country:US
Practice Address - Phone:503-222-3000
Practice Address - Fax:971-255-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty