Provider Demographics
NPI:1912018680
Name:LUSBY, AUDREY MARGARETH (DC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARGARETH
Last Name:LUSBY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 1/2 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132
Mailing Address - Country:US
Mailing Address - Phone:503-538-9867
Mailing Address - Fax:503-554-8388
Practice Address - Street 1:717 1/2 E FIRST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132
Practice Address - Country:US
Practice Address - Phone:503-538-9867
Practice Address - Fax:503-554-8388
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR032701Medicaid
0000QGFTFMedicare ID - Type Unspecified
OR032701Medicaid