Provider Demographics
NPI:1093923104
Name:PANZER, DAVID M (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:PANZER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1865 NW 169TH PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7327
Mailing Address - Country:US
Mailing Address - Phone:503-614-8300
Mailing Address - Fax:503-614-9081
Practice Address - Street 1:1865 NW 169TH PL
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7327
Practice Address - Country:US
Practice Address - Phone:503-614-8300
Practice Address - Fax:503-614-9081
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR1925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0-23082OtherBLUE CROSS
OR93-0840973OtherTIN
OR0000QGCRPMedicare ID - Type Unspecified