Provider Demographics
NPI:1659590388
Name:ACHTYES, KENT R (DC)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:R
Last Name:ACHTYES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KENT
Other - Middle Name:R
Other - Last Name:ACHTYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8001 SE POWELL BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2300
Mailing Address - Country:US
Mailing Address - Phone:503-772-3174
Mailing Address - Fax:503-772-4415
Practice Address - Street 1:8001 SE POWELL BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2300
Practice Address - Country:US
Practice Address - Phone:503-772-3174
Practice Address - Fax:503-772-4415
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 2396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor