Provider Demographics
NPI:1689146631
Name:PROHEALTH CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:PROHEALTH CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-261-1340
Mailing Address - Street 1:10249 NE CLACKAMAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3915
Mailing Address - Country:US
Mailing Address - Phone:503-206-6078
Mailing Address - Fax:503-889-0598
Practice Address - Street 1:10249 NE CLACKAMAS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3915
Practice Address - Country:US
Practice Address - Phone:503-206-6078
Practice Address - Fax:503-889-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty