Provider Demographics
NPI:1467966762
Name:HAYDEN ISLAND CHIROPRACTIC PAIN &
Entity Type:Organization
Organization Name:HAYDEN ISLAND CHIROPRACTIC PAIN &
Other - Org Name:ADIO SPINAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-206-6775
Mailing Address - Street 1:700 N HAYDEN ISLAND DR STE 335
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-8185
Mailing Address - Country:US
Mailing Address - Phone:503-206-6775
Mailing Address - Fax:
Practice Address - Street 1:700 N HAYDEN ISLAND DR STE 335
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-8185
Practice Address - Country:US
Practice Address - Phone:503-206-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty