Provider Demographics
NPI:1851470538
Name:HARPER, DWIGHT R (DC)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:R
Last Name:HARPER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 SE 101ST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3063
Mailing Address - Country:US
Mailing Address - Phone:503-252-7260
Mailing Address - Fax:503-252-4154
Practice Address - Street 1:2442 SE 101ST AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3063
Practice Address - Country:US
Practice Address - Phone:503-252-7260
Practice Address - Fax:503-252-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGCWDMedicare ID - Type UnspecifiedPROVIDER NUMBER