Provider Demographics
NPI:1689381451
Name:MACEIRAS, TRISTAN SANTIAGO (DC)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:SANTIAGO
Last Name:MACEIRAS
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 1:2712 NE 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5364
Mailing Address - Country:US
Mailing Address - Phone:512-695-0971
Mailing Address - Fax:
Practice Address - Street 1:5802 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2826
Practice Address - Country:US
Practice Address - Phone:503-714-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6256111NN0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor