Provider Demographics
NPI:1407551658
Name:I.MOVE. HEALTH AND PERFORMANCE
Entity Type:Organization
Organization Name:I.MOVE. HEALTH AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-236-4348
Mailing Address - Street 1:10729 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7601
Mailing Address - Country:US
Mailing Address - Phone:971-236-4348
Mailing Address - Fax:
Practice Address - Street 1:10729 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7601
Practice Address - Country:US
Practice Address - Phone:971-236-4348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty