Provider Demographics
NPI:1275736126
Name:REDMOND WELLNESS AND CHIROPRACTIC
Entity Type:Organization
Organization Name:REDMOND WELLNESS AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-923-2019
Mailing Address - Street 1:1655 SW HIGHLAND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2558
Mailing Address - Country:US
Mailing Address - Phone:541-923-2019
Mailing Address - Fax:541-923-4636
Practice Address - Street 1:1655 SW HIGHLAND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2558
Practice Address - Country:US
Practice Address - Phone:541-923-2019
Practice Address - Fax:541-923-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71 3734261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service