Provider Demographics
NPI:1609403898
Name:PROLIFIC WELLNESS
Entity Type:Organization
Organization Name:PROLIFIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, CCSP
Authorized Official - Phone:503-877-3199
Mailing Address - Street 1:375 SE 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3507
Mailing Address - Country:US
Mailing Address - Phone:503-334-8375
Mailing Address - Fax:
Practice Address - Street 1:4850 SW SCHOLLS FERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1692
Practice Address - Country:US
Practice Address - Phone:503-877-3199
Practice Address - Fax:503-212-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5782OtherBOARD LICENSE