Provider Demographics
NPI:1629283627
Name:INKROTE CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:INKROTE CHIROPRACTIC CLINIC, PC
Other - Org Name:LORI L INKROTE, DC, CCSP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:INKROTE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:503-829-5674
Mailing Address - Street 1:PO BOX 1364
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-0215
Mailing Address - Country:US
Mailing Address - Phone:503-829-5674
Mailing Address - Fax:
Practice Address - Street 1:217 N MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038
Practice Address - Country:US
Practice Address - Phone:503-829-5674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130725Medicare PIN