Provider Demographics
NPI:1568642908
Name:DESCHUTES ALTERNATIVE HEALTHCARE PC
Entity Type:Organization
Organization Name:DESCHUTES ALTERNATIVE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-382-9595
Mailing Address - Street 1:1425 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4160
Mailing Address - Country:US
Mailing Address - Phone:541-382-9595
Mailing Address - Fax:541-382-9595
Practice Address - Street 1:1425 NE REVERE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4160
Practice Address - Country:US
Practice Address - Phone:541-382-9595
Practice Address - Fax:541-382-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU52145Medicare UPIN
OR109310Medicare PIN