Provider Demographics
NPI:1558586578
Name:PORTLAND SPORTS AND INJURY CENTER LLC
Entity Type:Organization
Organization Name:PORTLAND SPORTS AND INJURY CENTER LLC
Other - Org Name:PROHEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-305-7244
Mailing Address - Street 1:4949 MEADOWS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3156
Mailing Address - Country:US
Mailing Address - Phone:503-305-7244
Mailing Address - Fax:503-305-8849
Practice Address - Street 1:4949 MEADOWS RD STE 140
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3156
Practice Address - Country:US
Practice Address - Phone:503-305-7244
Practice Address - Fax:503-305-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3260111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty