Provider Demographics
NPI:1851710818
Name:ILLO CHIROPRACTIC
Entity Type:Organization
Organization Name:ILLO CHIROPRACTIC
Other - Org Name:ANTHONY R. ILLO, D.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-624-7249
Mailing Address - Street 1:7340 SW HUNZIKER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8285
Mailing Address - Country:US
Mailing Address - Phone:503-624-7249
Mailing Address - Fax:503-684-4178
Practice Address - Street 1:7340 SW HUNZIKER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8285
Practice Address - Country:US
Practice Address - Phone:503-624-7249
Practice Address - Fax:503-684-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty