Provider Demographics
NPI:1164463295
Name:TOLLENAAR, CHRISTOPHER DRAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DRAKE
Last Name:TOLLENAAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DRAKE
Other - Middle Name:
Other - Last Name:TOLLENAAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11545 SW DURHAM RD
Mailing Address - Street 2:SUITE B 9
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224
Mailing Address - Country:US
Mailing Address - Phone:503-639-0778
Mailing Address - Fax:503-639-0815
Practice Address - Street 1:11545 SW DURHAM RD
Practice Address - Street 2:SUITE B 9
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:503-639-0778
Practice Address - Fax:503-639-0815
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORZ904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U54506Medicare UPIN
ORR110227Medicare ID - Type Unspecified