Provider Demographics
NPI:1235481615
Name:G. DAVID RHEAUME
Entity Type:Organization
Organization Name:G. DAVID RHEAUME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-BIRCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-342-6644
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-0467
Mailing Address - Country:US
Mailing Address - Phone:503-342-6644
Mailing Address - Fax:503-342-6017
Practice Address - Street 1:15351 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9667
Practice Address - Country:US
Practice Address - Phone:503-342-6644
Practice Address - Fax:503-342-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty