Provider Demographics
NPI:1508938705
Name:GARRY POW DC LLC
Entity Type:Organization
Organization Name:GARRY POW DC LLC
Other - Org Name:SUMMIT CHIROPRACTIC & MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:POW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-310-5842
Mailing Address - Street 1:10520 NE SISKIYOU ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2768
Mailing Address - Country:US
Mailing Address - Phone:503-310-5842
Mailing Address - Fax:503-650-4382
Practice Address - Street 1:6808 NE FOURTH PLAIN BLVD STE G
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7283
Practice Address - Country:US
Practice Address - Phone:360-750-7220
Practice Address - Fax:360-750-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131529Medicare PIN
WAGAB40206Medicare PIN
U76316Medicare UPIN