Provider Demographics
NPI:1225399132
Name:VALLEYVIEW CHIROPRACTIC & SPINE CENTER DBA GRESHAM CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:VALLEYVIEW CHIROPRACTIC & SPINE CENTER DBA GRESHAM CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-489-1998
Mailing Address - Street 1:575 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7511
Mailing Address - Country:US
Mailing Address - Phone:503-666-4531
Mailing Address - Fax:503-665-9997
Practice Address - Street 1:575 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7511
Practice Address - Country:US
Practice Address - Phone:503-666-4531
Practice Address - Fax:503-665-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty