Provider Demographics
NPI:1467628735
Name:DR SURAH HIRSCH DC & ASSOC PC
Entity Type:Organization
Organization Name:DR SURAH HIRSCH DC & ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-238-9788
Mailing Address - Street 1:3151 NE SANDY BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2500
Mailing Address - Country:US
Mailing Address - Phone:503-238-9788
Mailing Address - Fax:503-233-9163
Practice Address - Street 1:3151 NE SANDY BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2500
Practice Address - Country:US
Practice Address - Phone:503-238-9788
Practice Address - Fax:503-233-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 2037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000QGFWMOtherMEDICARE ID
08042100OtherREGENCE BCBS OF OREGON
08042100OtherREGENCE BCBS OF OREGON