Provider Demographics
NPI:1609321157
Name:CONERSTONE CHIROPRACTIC PS INC
Entity Type:Organization
Organization Name:CONERSTONE CHIROPRACTIC PS INC
Other - Org Name:OREGON CS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNGYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-746-5214
Mailing Address - Street 1:4655 SW GRIFFITH DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-8728
Mailing Address - Country:US
Mailing Address - Phone:503-746-5214
Mailing Address - Fax:
Practice Address - Street 1:4655 SW GRIFFITH DR
Practice Address - Street 2:SUITE 180
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8728
Practice Address - Country:US
Practice Address - Phone:503-746-5214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5621261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center