Provider Demographics
NPI:1124367230
Name:LIZ GILES DC LLC
Entity Type:Organization
Organization Name:LIZ GILES DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-702-2001
Mailing Address - Street 1:2262 N ALBINA AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1703
Mailing Address - Country:US
Mailing Address - Phone:503-702-2001
Mailing Address - Fax:
Practice Address - Street 1:2262 N ALBINA AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1703
Practice Address - Country:US
Practice Address - Phone:503-702-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty