Provider Demographics
NPI:1568829471
Name:GORGE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GORGE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-630-4442
Mailing Address - Street 1:1790 MAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1369
Mailing Address - Country:US
Mailing Address - Phone:541-630-4442
Mailing Address - Fax:844-444-1129
Practice Address - Street 1:1790 MAY ST STE B
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1369
Practice Address - Country:US
Practice Address - Phone:541-630-4442
Practice Address - Fax:844-444-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5090261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1720403744OtherINDIVIDUAL NPI