Provider Demographics
NPI:1518138379
Name:ESTACADA CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:ESTACADA CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TERRANCE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:503-630-4037
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-0037
Mailing Address - Country:US
Mailing Address - Phone:503-630-4037
Mailing Address - Fax:503-630-5636
Practice Address - Street 1:437 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-8528
Practice Address - Country:US
Practice Address - Phone:503-630-4037
Practice Address - Fax:503-630-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3195261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118010Medicare PIN