Provider Demographics
NPI:1326079377
Name:BRYAN BINGHAM D.C. P.C.
Entity Type:Organization
Organization Name:BRYAN BINGHAM D.C. P.C.
Other - Org Name:HIGHLAND CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-546-9987
Mailing Address - Street 1:3531 NE 15TH AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2377
Mailing Address - Country:US
Mailing Address - Phone:503-546-9987
Mailing Address - Fax:503-546-9988
Practice Address - Street 1:3531 NE 15TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2377
Practice Address - Country:US
Practice Address - Phone:503-546-9987
Practice Address - Fax:503-546-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty