Provider Demographics
NPI:1235379108
Name:CHIROPRACTIC AND ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC AND ACUPUNCTURE, INC.
Other - Org Name:ALIGN ACUPUNCTURE AND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:503-597-7780
Mailing Address - Street 1:1500 NW BETHANY BL.
Mailing Address - Street 2:STE. 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5236
Mailing Address - Country:US
Mailing Address - Phone:503-597-7780
Mailing Address - Fax:503-597-1301
Practice Address - Street 1:1500 NW BETHANY BL.
Practice Address - Street 2:STE. 200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5236
Practice Address - Country:US
Practice Address - Phone:503-597-7780
Practice Address - Fax:503-597-1301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC AND ACUPUNCTURE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-04
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3904111N00000X
ORAC01256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty