Provider Demographics
NPI:1790101699
Name:ENDEAVOR CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ENDEAVOR CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUDBACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-248-4476
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:STE 11
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-248-4476
Mailing Address - Fax:
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:STE 11
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-248-4476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty