Provider Demographics
NPI:1396865549
Name:PORTLAND INJURY &REHAB CENTER
Entity Type:Organization
Organization Name:PORTLAND INJURY &REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-236-8697
Mailing Address - Street 1:6230 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4718
Mailing Address - Country:US
Mailing Address - Phone:503-236-8697
Mailing Address - Fax:503-236-1525
Practice Address - Street 1:6230 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4718
Practice Address - Country:US
Practice Address - Phone:503-236-8697
Practice Address - Fax:503-236-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty