Provider Demographics
NPI:1124590088
Name:WILLAMETTE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WILLAMETTE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARCELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TETZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-975-8014
Mailing Address - Street 1:702 JOHN ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1955
Mailing Address - Country:US
Mailing Address - Phone:503-975-8014
Mailing Address - Fax:
Practice Address - Street 1:702 JOHN ADAMS ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1955
Practice Address - Country:US
Practice Address - Phone:503-975-8014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty