Provider Demographics
NPI:1578731659
Name:SHERWOOD CHIROPRACTIC & REHAB CENTER P C
Entity Type:Organization
Organization Name:SHERWOOD CHIROPRACTIC & REHAB CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-625-2225
Mailing Address - Street 1:20055 SW PACIFIC HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9294
Mailing Address - Country:US
Mailing Address - Phone:503-625-2225
Mailing Address - Fax:503-925-8840
Practice Address - Street 1:20055 SW PACIFIC HWY STE 210
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9294
Practice Address - Country:US
Practice Address - Phone:503-625-2225
Practice Address - Fax:503-925-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113764Medicare PIN