Provider Demographics
NPI:1386819977
Name:AGGER CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:AGGER CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JO ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHELBEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-310-9443
Mailing Address - Street 1:2705 E BURNSIDE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1767
Mailing Address - Country:US
Mailing Address - Phone:503-310-9443
Mailing Address - Fax:503-236-3182
Practice Address - Street 1:2705 E BURNSIDE ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1767
Practice Address - Country:US
Practice Address - Phone:503-236-1304
Practice Address - Fax:503-236-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101897Medicare PIN