Provider Demographics
NPI:1255650925
Name:CENTRO CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:CENTRO CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:JUNKIN
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:503-601-0210
Mailing Address - Street 1:1075 SE BASELINE ST
Mailing Address - Street 2:SUITE O
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4394
Mailing Address - Country:US
Mailing Address - Phone:503-601-0210
Mailing Address - Fax:503-601-0551
Practice Address - Street 1:1075 SE BASELINE ST
Practice Address - Street 2:SUITE O
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4394
Practice Address - Country:US
Practice Address - Phone:503-601-0210
Practice Address - Fax:503-601-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty