Provider Demographics
NPI:1285847772
Name:EAGLE CHIROPRACTIC
Entity Type:Organization
Organization Name:EAGLE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-677-6300
Mailing Address - Street 1:315 NE NASH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3245
Mailing Address - Country:US
Mailing Address - Phone:541-677-6300
Mailing Address - Fax:
Practice Address - Street 1:315 NE NASH ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3245
Practice Address - Country:US
Practice Address - Phone:541-677-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR102302Medicare UPIN
ORR102302Medicare ID - Type UnspecifiedMEDICARE PROVIDER #