Provider Demographics
NPI:1215210539
Name:OVERVOLD CHIROPRACTIC
Entity Type:Organization
Organization Name:OVERVOLD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OVERVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-282-7581
Mailing Address - Street 1:2106 NE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2064
Mailing Address - Country:US
Mailing Address - Phone:503-282-7581
Mailing Address - Fax:503-282-7581
Practice Address - Street 1:2106 NE 47TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2064
Practice Address - Country:US
Practice Address - Phone:503-282-7581
Practice Address - Fax:503-282-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty