Provider Demographics
NPI:1093834418
Name:FLOWERS, BILLY R (DC)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:R
Last Name:FLOWERS
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 1:2124 NE HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4739
Mailing Address - Country:US
Mailing Address - Phone:503-287-5504
Mailing Address - Fax:503-287-8913
Practice Address - Street 1:2124 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-4739
Practice Address - Country:US
Practice Address - Phone:503-287-5504
Practice Address - Fax:503-287-8913
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
931220365OtherFEDERAL TAX ID NUMBER