Provider Demographics
NPI:1164162020
Name:TERRY YCASAS, DC, LLC
Entity Type:Organization
Organization Name:TERRY YCASAS, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:YCASAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-866-4680
Mailing Address - Street 1:716 SE 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2469
Mailing Address - Country:US
Mailing Address - Phone:503-866-4680
Mailing Address - Fax:
Practice Address - Street 1:716 SE 11TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2469
Practice Address - Country:US
Practice Address - Phone:503-866-4680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERRY YCASAS, DC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty