Provider Demographics
NPI:1114420551
Name:VIP CHIROPRACTIC SERVICES, LLC
Entity Type:Organization
Organization Name:VIP CHIROPRACTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-709-5796
Mailing Address - Street 1:865 NE TOMAHAWK ISLAND DR # 102-306
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-8095
Mailing Address - Country:US
Mailing Address - Phone:971-808-1382
Mailing Address - Fax:503-336-1033
Practice Address - Street 1:865 NE TOMAHAWK ISLAND DR # 102-306
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-8095
Practice Address - Country:US
Practice Address - Phone:971-808-1382
Practice Address - Fax:503-336-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3500111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty