Provider Demographics
NPI:1629390232
Name:OUELLETTE, MOLLY (DC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 N COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2339
Mailing Address - Country:US
Mailing Address - Phone:503-223-0900
Mailing Address - Fax:503-223-1188
Practice Address - Street 1:2024 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2245
Practice Address - Country:US
Practice Address - Phone:503-238-6262
Practice Address - Fax:503-473-8047
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3992111N00000X
MA3327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor