Provider Demographics
NPI:1891455333
Name:PRECISION CHIROPRACTIC OF PORTLAND
Entity Type:Organization
Organization Name:PRECISION CHIROPRACTIC OF PORTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-260-7931
Mailing Address - Street 1:104 S KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-5271
Mailing Address - Country:US
Mailing Address - Phone:217-260-7931
Mailing Address - Fax:
Practice Address - Street 1:826 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1622
Practice Address - Country:US
Practice Address - Phone:217-260-7931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1699114546OtherNPPES