Provider Demographics
NPI:1225384761
Name:CLATSKANIE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:CLATSKANIE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANDIS-PEIRAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-728-4978
Mailing Address - Street 1:50 NW 4TH ST.
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-1415
Mailing Address - Country:US
Mailing Address - Phone:503-728-4978
Mailing Address - Fax:503-728-9021
Practice Address - Street 1:50 NW 4TH ST.
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016-1415
Practice Address - Country:US
Practice Address - Phone:503-728-4978
Practice Address - Fax:509-728-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR100448Medicare UPIN