Provider Demographics
NPI:1508034018
Name:OROFINO CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:OROFINO CHIROPRACTIC, PLLC
Other - Org Name:OROFINO SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTICTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HARTSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-476-7091
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1328
Mailing Address - Country:US
Mailing Address - Phone:208-476-7091
Mailing Address - Fax:
Practice Address - Street 1:437 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9998
Practice Address - Country:US
Practice Address - Phone:208-476-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty