Provider Demographics
NPI:1619022290
Name:BHALERAO, SHIREESH (DC)
Entity Type:Individual
Prefix:
First Name:SHIREESH
Middle Name:
Last Name:BHALERAO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 NW GLISAN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2225
Mailing Address - Country:US
Mailing Address - Phone:503-228-5000
Mailing Address - Fax:
Practice Address - Street 1:1706 NW GLISAN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2225
Practice Address - Country:US
Practice Address - Phone:503-228-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor