Provider Demographics
NPI:1518342468
Name:120 CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:120 CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ANDOSCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-535-7643
Mailing Address - Street 1:1836 NE 7TH AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3978
Mailing Address - Country:US
Mailing Address - Phone:503-506-5120
Mailing Address - Fax:503-506-5121
Practice Address - Street 1:1836 NE 7TH AVE STE 109
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3978
Practice Address - Country:US
Practice Address - Phone:503-506-5120
Practice Address - Fax:503-506-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty