Provider Demographics
NPI:1639417413
Name:EUGENE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:EUGENE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-484-2004
Mailing Address - Street 1:2160 W 11TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3564
Mailing Address - Country:US
Mailing Address - Phone:541-484-2004
Mailing Address - Fax:541-484-0800
Practice Address - Street 1:2160 W 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3564
Practice Address - Country:US
Practice Address - Phone:541-484-2004
Practice Address - Fax:541-484-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1732111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U31461Medicare UPIN