Provider Demographics
NPI:1841411626
Name:ESTRELLA QUIROPRACTICO
Entity Type:Organization
Organization Name:ESTRELLA QUIROPRACTICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:503-939-3462
Mailing Address - Street 1:8147 SW SENECA ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8416
Mailing Address - Country:US
Mailing Address - Phone:503-612-9981
Mailing Address - Fax:503-885-9522
Practice Address - Street 1:1895 SE TUALATIN VALLEY HWY
Practice Address - Street 2:SUITE
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5061
Practice Address - Country:US
Practice Address - Phone:503-939-3462
Practice Address - Fax:503-885-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty