Provider Demographics
NPI:1568408706
Name:COLEMAN, MARY T (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10365 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5741
Mailing Address - Country:US
Mailing Address - Phone:503-887-7725
Mailing Address - Fax:503-406-2550
Practice Address - Street 1:10365 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5741
Practice Address - Country:US
Practice Address - Phone:503-887-7725
Practice Address - Fax:503-406-2550
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
113606Medicare ID - Type Unspecified
ORU90807Medicare UPIN