Provider Demographics
NPI:1639453376
Name:DAVID M PANZER, D.C.
Entity Type:Organization
Organization Name:DAVID M PANZER, D.C.
Other - Org Name:BASELINE CHIROPRACTIC CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:PANZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-614-8300
Mailing Address - Street 1:1865 NW 169TH PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7327
Mailing Address - Country:US
Mailing Address - Phone:503-614-8300
Mailing Address - Fax:503-614-9081
Practice Address - Street 1:1865 NW 169TH PL
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7327
Practice Address - Country:US
Practice Address - Phone:503-614-8300
Practice Address - Fax:503-614-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1925261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0-23082OtherBLUE CROSS
OR0000QGCRPOtherMEDICARE
OR1093923104OtherNPI