Provider Demographics
NPI:1811234230
Name:SOUL TO SOUL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SOUL TO SOUL CHIROPRACTIC LLC
Other - Org Name:SOUL TO SOUL CHIROPRACTIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEKEBO
Authorized Official - Middle Name:M
Authorized Official - Last Name:YADETO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-915-3427
Mailing Address - Street 1:12661 SE POWELL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3400
Mailing Address - Country:US
Mailing Address - Phone:503-954-3784
Mailing Address - Fax:503-208-3336
Practice Address - Street 1:12661 SE POWELL BLVD STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3400
Practice Address - Country:US
Practice Address - Phone:503-915-3427
Practice Address - Fax:503-477-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome HealthGroup - Single Specialty