Provider Demographics
NPI:1497714604
Name:PULLEY, SONJA M (DC)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:M
Last Name:PULLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1929
Mailing Address - Country:US
Mailing Address - Phone:503-252-2533
Mailing Address - Fax:503-252-2532
Practice Address - Street 1:12508 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1929
Practice Address - Country:US
Practice Address - Phone:503-252-2533
Practice Address - Fax:503-252-2532
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGDXBMedicare ID - Type Unspecified
ORT68025Medicare UPIN