Provider Demographics
NPI:1679803043
Name:BLUE MOUNTAIN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEGEHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-276-1938
Mailing Address - Street 1:424 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2026
Mailing Address - Country:US
Mailing Address - Phone:541-276-1938
Mailing Address - Fax:541-276-7062
Practice Address - Street 1:424 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2026
Practice Address - Country:US
Practice Address - Phone:541-276-1938
Practice Address - Fax:541-276-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2688261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center