Provider Demographics
NPI:1669842738
Name:PROUTY, CHRISTOPHER TOBIAS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TOBIAS
Last Name:PROUTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SE BASELINE ST
Mailing Address - Street 2:STE D
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4394
Mailing Address - Country:US
Mailing Address - Phone:503-981-1155
Mailing Address - Fax:
Practice Address - Street 1:1075 SE BASELINE ST
Practice Address - Street 2:STE D
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4394
Practice Address - Country:US
Practice Address - Phone:503-981-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor