Provider Demographics
NPI:1821370784
Name:MEHAN, AUDRA GAYE (DC)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:GAYE
Last Name:MEHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18813 WILLAMETTE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1711
Mailing Address - Country:US
Mailing Address - Phone:503-656-1415
Mailing Address - Fax:503-722-3938
Practice Address - Street 1:18813 WILLAMETTE DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1711
Practice Address - Country:US
Practice Address - Phone:503-656-1415
Practice Address - Fax:503-722-3938
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor