Provider Demographics
NPI:1518138239
Name:CLINE CHIROPRACTIC REHABILITATION CENTER LLC.
Entity Type:Organization
Organization Name:CLINE CHIROPRACTIC REHABILITATION CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-679-0741
Mailing Address - Street 1:5010 GRANGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-5846
Mailing Address - Country:US
Mailing Address - Phone:541-679-0741
Mailing Address - Fax:541-679-0751
Practice Address - Street 1:5010 GRANGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-5846
Practice Address - Country:US
Practice Address - Phone:541-679-0741
Practice Address - Fax:541-679-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU99166Medicare UPIN
ORR131888Medicare PIN