Provider Demographics
NPI:1528217551
Name:LEVY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LEVY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:971-344-4146
Mailing Address - Street 1:2538 NE BROADWAY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1872
Mailing Address - Country:US
Mailing Address - Phone:971-344-4146
Mailing Address - Fax:503-287-0967
Practice Address - Street 1:2538 NE BROADWAY ST
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1872
Practice Address - Country:US
Practice Address - Phone:971-344-4146
Practice Address - Fax:503-287-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71-3723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty