Provider Demographics
NPI:1790766020
Name:HIRSCH, SURAH H (DC)
Entity Type:Individual
Prefix:DR
First Name:SURAH
Middle Name:H
Last Name:HIRSCH
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 1:3151 NE SANDY BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2500
Mailing Address - Country:US
Mailing Address - Phone:503-238-9788
Mailing Address - Fax:503-233-9163
Practice Address - Street 1:3151 NE SANDY BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2500
Practice Address - Country:US
Practice Address - Phone:503-238-9788
Practice Address - Fax:503-233-9163
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR2037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080421000OtherREGENCE BCBSO
T67724Medicare UPIN
0000QGFWMMedicare ID - Type Unspecified