Provider Demographics
NPI:1750324075
Name:PITCAIRN, THERESA ANN (DC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:PITCAIRN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 AUMSVILLE HWY SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9117
Mailing Address - Country:US
Mailing Address - Phone:503-743-1800
Mailing Address - Fax:503-743-1801
Practice Address - Street 1:625 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUMSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97325-9020
Practice Address - Country:US
Practice Address - Phone:503-743-1800
Practice Address - Fax:503-743-1801
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor