Provider Demographics
NPI:1316017593
Name:CONKLIN, DAVID SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 SE WOODSTOCK BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6212
Mailing Address - Country:US
Mailing Address - Phone:503-777-4221
Mailing Address - Fax:503-777-4349
Practice Address - Street 1:4309 SE WOODSTOCK BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6212
Practice Address - Country:US
Practice Address - Phone:503-777-4221
Practice Address - Fax:503-777-4349
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGHJSMedicare ID - Type Unspecified