Provider Demographics
NPI:1396193207
Name:KHALSA CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:KHALSA CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURUKA
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-362-2623
Mailing Address - Street 1:830 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4108
Mailing Address - Country:US
Mailing Address - Phone:503-362-2623
Mailing Address - Fax:503-362-2558
Practice Address - Street 1:830 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4108
Practice Address - Country:US
Practice Address - Phone:503-362-2623
Practice Address - Fax:503-362-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2097261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1770625097Medicare UPIN