Provider Demographics
NPI:1427014364
Name:AGGER, SIMON JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:JOHN
Last Name:AGGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 E BURNSIDE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1767
Mailing Address - Country:US
Mailing Address - Phone:503-236-1304
Mailing Address - Fax:503-236-3182
Practice Address - Street 1:2705 E BURNSIDE ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1767
Practice Address - Country:US
Practice Address - Phone:503-236-1304
Practice Address - Fax:503-236-3182
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101897Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER