Provider Demographics
NPI:1578736740
Name:ASPEN CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:ASPEN CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-291-7155
Mailing Address - Street 1:7417 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2169
Mailing Address - Country:US
Mailing Address - Phone:503-291-7155
Mailing Address - Fax:503-291-7152
Practice Address - Street 1:7417 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2169
Practice Address - Country:US
Practice Address - Phone:503-291-7155
Practice Address - Fax:503-291-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service