Provider Demographics
NPI:1295844116
Name:NEWBERG FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:NEWBERG FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-554-0661
Mailing Address - Street 1:114 E HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2822
Mailing Address - Country:US
Mailing Address - Phone:503-554-0661
Mailing Address - Fax:503-554-9126
Practice Address - Street 1:114 E HANCOCK ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2822
Practice Address - Country:US
Practice Address - Phone:503-554-0661
Practice Address - Fax:503-554-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113538Medicare ID - Type Unspecified