Provider Demographics
NPI:1437363322
Name:ABRAHAMSON, SCOTT E (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:ABRAHAMSON
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 1:15800 BOONES FERRY RD STE A1
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3426
Mailing Address - Country:US
Mailing Address - Phone:503-635-6246
Mailing Address - Fax:503-635-1450
Practice Address - Street 1:15800 BOONES FERRY RD STE A1
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3426
Practice Address - Country:US
Practice Address - Phone:503-635-6246
Practice Address - Fax:503-635-1450
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67376Medicare ID - Type UnspecifiedCHIROPRACTOR- NON PAR