Provider Demographics
NPI:1568720217
Name:PORTLAND CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:PORTLAND CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SENH
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-255-0306
Mailing Address - Street 1:10303 NE WEIDLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3882
Mailing Address - Country:US
Mailing Address - Phone:503-255-0306
Mailing Address - Fax:503-257-1452
Practice Address - Street 1:10303 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3882
Practice Address - Country:US
Practice Address - Phone:503-255-0306
Practice Address - Fax:503-257-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty