Provider Demographics
NPI:1164768818
Name:TV HIGHWAY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:TV HIGHWAY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-642-6018
Mailing Address - Street 1:18055 SW TV HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3953
Mailing Address - Country:US
Mailing Address - Phone:503-642-3018
Mailing Address - Fax:
Practice Address - Street 1:18055 SW TV HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3953
Practice Address - Country:US
Practice Address - Phone:503-642-3018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4091261Q00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy