Provider Demographics
NPI:1093727034
Name:HARVARD CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:HARVARD CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEDAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-673-8270
Mailing Address - Street 1:2365 W HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2570
Mailing Address - Country:US
Mailing Address - Phone:541-673-8270
Mailing Address - Fax:541-673-0283
Practice Address - Street 1:2365 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2570
Practice Address - Country:US
Practice Address - Phone:541-673-8270
Practice Address - Fax:541-673-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2817111N00000X
OR27-2877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty