Provider Demographics
NPI:1457670515
Name:CHIROPRACTIC AND ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC AND ACUPUNCTURE LLC
Other - Org Name:ALIGN ACUPUNCTURE AND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:503-597-7780
Mailing Address - Street 1:1500 NW BETHANY BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5208
Mailing Address - Country:US
Mailing Address - Phone:503-597-7780
Mailing Address - Fax:503-597-1301
Practice Address - Street 1:1500 NW BETHANY BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5208
Practice Address - Country:US
Practice Address - Phone:503-597-7780
Practice Address - Fax:503-597-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3904111N00000X
ORAC01256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherIRS