Provider Demographics
NPI:1326327404
Name:POWER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:POWER CHIROPRACTIC CLINIC
Other - Org Name:HICKEL CHIRIOPRACTIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-786-7786
Mailing Address - Street 1:8305 SE MONTEREY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7728
Mailing Address - Country:US
Mailing Address - Phone:503-786-7786
Mailing Address - Fax:503-786-7191
Practice Address - Street 1:8305 SE MONTEREY AVE STE 104
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7728
Practice Address - Country:US
Practice Address - Phone:503-786-7786
Practice Address - Fax:503-786-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 - 3057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1023140969OtherNPI (TYPE1) 1023140969
OR1023140969OtherNPI (TYPE1) 1023140969