Provider Demographics
NPI:1699005884
Name:CORNELIUS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CORNELIUS CHIROPRACTIC LLC
Other - Org Name:OREGON SPINE AND DISC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC BS
Authorized Official - Phone:503-626-3700
Mailing Address - Street 1:5035 NE ELAM YOUNG PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6425
Mailing Address - Country:US
Mailing Address - Phone:503-626-3700
Mailing Address - Fax:503-643-6667
Practice Address - Street 1:5035 NE ELAM YOUNG PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6425
Practice Address - Country:US
Practice Address - Phone:503-626-3700
Practice Address - Fax:503-643-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty