Provider Demographics
NPI:1710056791
Name:BOURLON, PATRICK DENIS (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DENIS
Last Name:BOURLON
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 1:233 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4023
Mailing Address - Country:US
Mailing Address - Phone:503-648-1088
Mailing Address - Fax:503-648-0748
Practice Address - Street 1:233 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4023
Practice Address - Country:US
Practice Address - Phone:503-648-1088
Practice Address - Fax:503-648-0748
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR102368OtherCLINIC MEDICARE NUMBER
OR023051002OtherBLUE CROSS
WA0147111OtherWASHINGTON STATE LABOR
ORU86892Medicare UPIN
WA0147111OtherWASHINGTON STATE LABOR