Provider Demographics
NPI:1639347511
Name:EMMERT CHIROPRACTIC COMPANY
Entity Type:Organization
Organization Name:EMMERT CHIROPRACTIC COMPANY
Other - Org Name:MCNOWN CHIROPRACTICCLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-557-1122
Mailing Address - Street 1:1830 BLANKENSHIP RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068
Mailing Address - Country:US
Mailing Address - Phone:503-557-1122
Mailing Address - Fax:503-557-1119
Practice Address - Street 1:1830 BLANKENSHIP RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068
Practice Address - Country:US
Practice Address - Phone:503-557-1122
Practice Address - Fax:503-557-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5111261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113953Medicare PIN
ORR113952OtherMEDICARE GROUP
ORU78268Medicare UPIN