Provider Demographics
NPI:1336301456
Name:MAIN STREET CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MAIN STREET CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-258-6744
Mailing Address - Street 1:727 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-3209
Mailing Address - Country:US
Mailing Address - Phone:541-258-6744
Mailing Address - Fax:541-258-8668
Practice Address - Street 1:727 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3209
Practice Address - Country:US
Practice Address - Phone:541-258-6744
Practice Address - Fax:541-258-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty