Provider Demographics
NPI:1336646421
Name:NWMC CHIROPRACTIC CARE LLC
Entity Type:Organization
Organization Name:NWMC CHIROPRACTIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-462-0407
Mailing Address - Street 1:1350 SE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1203
Mailing Address - Country:US
Mailing Address - Phone:503-509-4840
Mailing Address - Fax:503-894-9557
Practice Address - Street 1:1350 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1203
Practice Address - Country:US
Practice Address - Phone:503-889-0906
Practice Address - Fax:503-894-9557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NWMC CHIROPRACTIC AND MASSAGE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty