Provider Demographics
NPI:1629601372
Name:ROBLES, MEGAN ADELE (DC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ADELE
Last Name:ROBLES
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 1:2100 NE BROADWAY ST STE 255
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1544
Mailing Address - Country:US
Mailing Address - Phone:503-719-5000
Mailing Address - Fax:971-255-1754
Practice Address - Street 1:2100 NE BROADWAY ST STE 255
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1544
Practice Address - Country:US
Practice Address - Phone:503-719-5000
Practice Address - Fax:971-255-1754
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor