Provider Demographics
NPI:1669862256
Name:VANDERLOO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VANDERLOO CHIROPRACTIC LLC
Other - Org Name:FLORES CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:VANDERLOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:971-255-1922
Mailing Address - Street 1:2230 W BURNSIDE ST STE D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3727
Mailing Address - Country:US
Mailing Address - Phone:971-255-1922
Mailing Address - Fax:971-250-2884
Practice Address - Street 1:2230 W BURNSIDE ST STE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3727
Practice Address - Country:US
Practice Address - Phone:971-255-1922
Practice Address - Fax:971-250-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG8913150OtherMEDICARE PTAN