Provider Demographics
NPI:1710759816
Name:CABALLERO TRUJEQUE, RUBEN ADRIAN
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:ADRIAN
Last Name:CABALLERO TRUJEQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 SW DENNEY RD UNIT 71
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6113
Mailing Address - Country:US
Mailing Address - Phone:971-340-5113
Mailing Address - Fax:
Practice Address - Street 1:11900 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2976
Practice Address - Country:US
Practice Address - Phone:971-245-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor