Provider Demographics
NPI:1538119805
Name:CASCADE LIVING LLC
Entity Type:Organization
Organization Name:CASCADE LIVING LLC
Other - Org Name:SLATER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-447-6627
Mailing Address - Street 1:240 NW CLAYPOOL ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1842
Mailing Address - Country:US
Mailing Address - Phone:541-447-6627
Mailing Address - Fax:541-447-6193
Practice Address - Street 1:240 NW CLAYPOOL ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1842
Practice Address - Country:US
Practice Address - Phone:541-447-6627
Practice Address - Fax:541-447-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORV44272Medicare UPIN