Provider Demographics
NPI:1871670588
Name:BROUSE, RICHARD O (DC CLN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:O
Last Name:BROUSE
Suffix:
Gender:M
Credentials:DC CLN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD
Mailing Address - Street 2:#111
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-654-3225
Mailing Address - Fax:503-654-3056
Practice Address - Street 1:8800 SUNNYSIDE RD
Practice Address - Street 2:#111
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-654-3225
Practice Address - Fax:503-654-3056
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271359111NR0400X
10333348133N00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
T67455Medicare UPIN