Provider Demographics
NPI:1710017595
Name:BLUE MOUNTAIN CHIROPRACTIC HEALTH CENTER INC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-575-1063
Mailing Address - Street 1:155 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-1101
Mailing Address - Country:US
Mailing Address - Phone:541-575-1063
Mailing Address - Fax:541-575-5554
Practice Address - Street 1:155 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1101
Practice Address - Country:US
Practice Address - Phone:541-575-1063
Practice Address - Fax:541-575-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2692261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000QGFQZMedicare ID - Type Unspecified
ORU19384Medicare UPIN