Provider Demographics
NPI:1861851180
Name:BRENDA KU, DC LLC
Entity Type:Organization
Organization Name:BRENDA KU, DC LLC
Other - Org Name:CONNECT CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-680-3568
Mailing Address - Street 1:5821 N HAIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2111
Mailing Address - Country:US
Mailing Address - Phone:503-680-3568
Mailing Address - Fax:
Practice Address - Street 1:3821 NE MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1114
Practice Address - Country:US
Practice Address - Phone:503-680-3568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty