Provider Demographics
NPI:1114453164
Name:SEASIDE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:SEASIDE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:OTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-738-3331
Mailing Address - Street 1:1500 S ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6512
Mailing Address - Country:US
Mailing Address - Phone:503-738-3331
Mailing Address - Fax:503-738-3332
Practice Address - Street 1:1500 S ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6512
Practice Address - Country:US
Practice Address - Phone:503-738-3331
Practice Address - Fax:503-738-3332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEASIDE CHIROPRACTIC CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR67977Medicare UPIN
ORR0000QGCOBMedicare PIN