Provider Demographics
NPI:1255864922
Name:DRPARADISE INC
Entity Type:Organization
Organization Name:DRPARADISE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADISE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-936-6182
Mailing Address - Street 1:2125 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1606
Mailing Address - Country:US
Mailing Address - Phone:503-936-6182
Mailing Address - Fax:
Practice Address - Street 1:2125 SE OAK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1606
Practice Address - Country:US
Practice Address - Phone:503-936-6182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty