Provider Demographics
NPI:1659882645
Name:PREMIER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-400-5259
Mailing Address - Street 1:3000 MARKET ST NE STE 268
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1809
Mailing Address - Country:US
Mailing Address - Phone:503-584-1620
Mailing Address - Fax:503-990-6985
Practice Address - Street 1:3000 MARKET ST NE STE 268
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1809
Practice Address - Country:US
Practice Address - Phone:503-584-1620
Practice Address - Fax:503-990-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty