Provider Demographics
NPI:1790968220
Name:GUSTAV E SCHEFSTROM
Entity Type:Organization
Organization Name:GUSTAV E SCHEFSTROM
Other - Org Name:ROGUE VALLEY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAV
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHEFSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC BCAO
Authorized Official - Phone:541-779-8338
Mailing Address - Street 1:1744 E MCANDREWS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5576
Mailing Address - Country:US
Mailing Address - Phone:541-779-8338
Mailing Address - Fax:541-858-0749
Practice Address - Street 1:1744 E MCANDREWS RD
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5576
Practice Address - Country:US
Practice Address - Phone:541-779-8338
Practice Address - Fax:541-858-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR112380OtherMEDICARE GRP
ORR112382OtherMEDICARE PROVIDER
OR350008024OtherRR MEDICARE
ORT68098Medicare UPIN