Provider Demographics
NPI:1518133214
Name:SAM S MOURSALIAN DC PC
Entity Type:Organization
Organization Name:SAM S MOURSALIAN DC PC
Other - Org Name:PURE HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:SARKIS
Authorized Official - Last Name:MOURSALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-779-4243
Mailing Address - Street 1:3455 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1357
Mailing Address - Country:US
Mailing Address - Phone:503-779-4243
Mailing Address - Fax:503-586-0263
Practice Address - Street 1:3455 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1357
Practice Address - Country:US
Practice Address - Phone:503-779-4243
Practice Address - Fax:503-586-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005708Medicaid
ORV08345OtherUPIN
OR1407875594OtherTYPE I NPI