Provider Demographics
NPI:1124569017
Name:SCHOEN, GRANT
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:SCHOEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NW LOVEJOY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2861
Mailing Address - Country:US
Mailing Address - Phone:503-746-9926
Mailing Address - Fax:
Practice Address - Street 1:2525 NW LOVEJOY ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2861
Practice Address - Country:US
Practice Address - Phone:503-746-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6162111N00000X
CA33748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor