Provider Demographics
NPI:1801381470
Name:ASPEN CHIROPRACTIC ASSOCIATES PC
Entity Type:Organization
Organization Name:ASPEN CHIROPRACTIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-584-1620
Mailing Address - Street 1:14115 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2628
Mailing Address - Country:US
Mailing Address - Phone:503-841-6633
Mailing Address - Fax:503-841-6594
Practice Address - Street 1:14115 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2628
Practice Address - Country:US
Practice Address - Phone:503-249-0114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty