Provider Demographics
NPI:1861043804
Name:EMPOWER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EMPOWER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-889-0130
Mailing Address - Street 1:2515 NW MONTEREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 NW HAWTHORNE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2958
Practice Address - Country:US
Practice Address - Phone:563-889-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty