Provider Demographics
NPI:1083754659
Name:BRYAN BAISINGER, PC
Entity Type:Organization
Organization Name:BRYAN BAISINGER, PC
Other - Org Name:CLEARWATER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-279-0205
Mailing Address - Street 1:1201 SW 12TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2035
Mailing Address - Country:US
Mailing Address - Phone:503-279-0205
Mailing Address - Fax:503-279-0206
Practice Address - Street 1:1201 SW 12TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2035
Practice Address - Country:US
Practice Address - Phone:503-279-0205
Practice Address - Fax:503-279-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272919111N00000X
OR273550111N00000X
OR0914175F00000X
OR1348175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty