Provider Demographics
NPI:1326456641
Name:MDC CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MDC CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYDOUANGCHANH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-249-0114
Mailing Address - Street 1:4410 NE FREMONT ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1154
Mailing Address - Country:US
Mailing Address - Phone:503-249-0114
Mailing Address - Fax:503-214-8175
Practice Address - Street 1:4410 NE FREMONT ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213
Practice Address - Country:US
Practice Address - Phone:503-249-0114
Practice Address - Fax:503-214-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty