Provider Demographics
NPI:1790956555
Name:GENESS, GEOFF (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:GEOFF
Middle Name:
Last Name:GENESS
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 SE BELMONT ST
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1974
Mailing Address - Country:US
Mailing Address - Phone:503-236-8701
Mailing Address - Fax:503-236-8710
Practice Address - Street 1:6040 SE BELMONT ST
Practice Address - Street 2:SUITE 1230
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1974
Practice Address - Country:US
Practice Address - Phone:503-236-8701
Practice Address - Fax:503-236-8710
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71 3762111N00000X
ORAC160346171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist