Provider Demographics
NPI:1407020290
Name:BRIDGETOWN CHIROPRACTIC AND WELLNESS PC
Entity Type:Organization
Organization Name:BRIDGETOWN CHIROPRACTIC AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-490-5647
Mailing Address - Street 1:7727 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6360
Mailing Address - Country:US
Mailing Address - Phone:503-490-5647
Mailing Address - Fax:
Practice Address - Street 1:7727 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6360
Practice Address - Country:US
Practice Address - Phone:503-490-5647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273541111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty