Provider Demographics
NPI:1659964013
Name:RIO REHABILITATION CLINIC LLC
Entity Type:Organization
Organization Name:RIO REHABILITATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-247-8717
Mailing Address - Street 1:16742 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1414
Mailing Address - Country:US
Mailing Address - Phone:503-386-1993
Mailing Address - Fax:503-386-1993
Practice Address - Street 1:16742 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1414
Practice Address - Country:US
Practice Address - Phone:503-386-1993
Practice Address - Fax:503-386-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500706674Medicaid