Provider Demographics
NPI:1780868646
Name:HIRO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HIRO CHIROPRACTIC LLC
Other - Org Name:ESSENCE OF HEALTH CHIROPRACTIC HIRO MATSUNO,D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIROYUKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-726-7151
Mailing Address - Street 1:1317 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3424
Mailing Address - Country:US
Mailing Address - Phone:541-726-7151
Mailing Address - Fax:541-746-2225
Practice Address - Street 1:1317 18TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3424
Practice Address - Country:US
Practice Address - Phone:541-726-7151
Practice Address - Fax:541-746-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR103931Medicare PIN