Provider Demographics
NPI:1891829370
Name:SOUTHERN OREGON CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SOUTHERN OREGON CHIROPRACTIC, LLC
Other - Org Name:SOUTHERN OREGON ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:541-414-0362
Mailing Address - Street 1:1744 E MCANDREW RD
Mailing Address - Street 2:SUITE D.
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-245-4444
Mailing Address - Fax:541-245-4443
Practice Address - Street 1:2931 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8127
Practice Address - Country:US
Practice Address - Phone:541-245-4444
Practice Address - Fax:541-200-2269
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN OREGON CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273544111N00000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023096Medicaid
OR023096Medicaid