Provider Demographics
NPI:1700041738
Name:SPELLMEYER CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SPELLMEYER CHIROPRACTIC, INC.
Other - Org Name:AMY SPELLMEYER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPELLMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-693-9101
Mailing Address - Street 1:14145 SW NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2641
Mailing Address - Country:US
Mailing Address - Phone:503-693-9101
Mailing Address - Fax:
Practice Address - Street 1:5215 NE ELAM YOUNG PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6498
Practice Address - Country:US
Practice Address - Phone:503-693-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty