Provider Demographics
NPI:1346587227
Name:BORGARDT, KEENAN GOTTLIEB (DC)
Entity Type:Individual
Prefix:DR
First Name:KEENAN
Middle Name:GOTTLIEB
Last Name:BORGARDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 NE 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2703
Mailing Address - Country:US
Mailing Address - Phone:503-440-7470
Mailing Address - Fax:
Practice Address - Street 1:5253 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2562
Practice Address - Country:US
Practice Address - Phone:503-766-4881
Practice Address - Fax:503-914-0923
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor