Provider Demographics
NPI:1295226918
Name:BOBBY MAYBEE DC LLC
Entity Type:Organization
Organization Name:BOBBY MAYBEE DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-459-6277
Mailing Address - Street 1:1836 NE 7TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3996
Mailing Address - Country:US
Mailing Address - Phone:805-459-6277
Mailing Address - Fax:
Practice Address - Street 1:1836 NE 7TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3996
Practice Address - Country:US
Practice Address - Phone:805-459-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306855192Medicaid