Provider Demographics
NPI:1518621853
Name:PIONEER CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:PIONEER CHIROPRACTIC & WELLNESS
Other - Org Name:CRESTVIEW CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-488-5485
Mailing Address - Street 1:7340 SW HUNZIKER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2303
Mailing Address - Country:US
Mailing Address - Phone:503-488-5485
Mailing Address - Fax:
Practice Address - Street 1:7340 SW HUNZIKER RD STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2303
Practice Address - Country:US
Practice Address - Phone:503-488-5485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty