Provider Demographics
NPI:1578685582
Name:HANDS-ON HEALTHCARE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:HANDS-ON HEALTHCARE CHIROPRACTIC, PC
Other - Org Name:SYNERGEA CHIROPRACTIC: A CREATING WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:NYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-207-1087
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-0455
Mailing Address - Country:US
Mailing Address - Phone:541-207-1087
Mailing Address - Fax:
Practice Address - Street 1:111 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9621
Practice Address - Country:US
Practice Address - Phone:541-207-1087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3506261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR120061Medicare PIN