Provider Demographics
NPI:1417142530
Name:BOONES FERRY CHIROPRACTIC AND MASSAGE PC
Entity Type:Organization
Organization Name:BOONES FERRY CHIROPRACTIC AND MASSAGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NIENABER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-682-6778
Mailing Address - Street 1:30789 SW BOONES FERRY RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7842
Mailing Address - Country:US
Mailing Address - Phone:503-682-6778
Mailing Address - Fax:503-682-6744
Practice Address - Street 1:30789 SW BOONES FERRY RD
Practice Address - Street 2:SUITE P
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7842
Practice Address - Country:US
Practice Address - Phone:503-682-6778
Practice Address - Fax:503-682-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133699Medicare PIN