Provider Demographics
NPI:1518046291
Name:SPINK, DAMON PAUL (DC)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:PAUL
Last Name:SPINK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3072 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1396
Mailing Address - Country:US
Mailing Address - Phone:503-391-0848
Mailing Address - Fax:
Practice Address - Street 1:3072 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1396
Practice Address - Country:US
Practice Address - Phone:503-391-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGHKFMedicare ID - Type UnspecifiedMEDICARE PART B