Provider Demographics
NPI:1790950228
Name:SPRINGWATER CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SPRINGWATER CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-465-9100
Mailing Address - Street 1:1659 NE MARKET DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-3867
Mailing Address - Country:US
Mailing Address - Phone:503-465-9100
Mailing Address - Fax:503-665-2290
Practice Address - Street 1:1659 NE MARKET DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-3867
Practice Address - Country:US
Practice Address - Phone:503-465-9100
Practice Address - Fax:503-665-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty