Provider Demographics
NPI:1891401592
Name:BEN KHALIFA, SLIM
Entity Type:Individual
Prefix:
First Name:SLIM
Middle Name:
Last Name:BEN KHALIFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 SW 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3302
Mailing Address - Country:US
Mailing Address - Phone:781-588-1018
Mailing Address - Fax:
Practice Address - Street 1:2251 SE TV HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7975
Practice Address - Country:US
Practice Address - Phone:501-648-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor