Provider Demographics
NPI:1912182965
Name:CDL CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:CDL CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:DUGGAN
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-892-3600
Mailing Address - Street 1:1410 SW MARLOW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5145
Mailing Address - Country:US
Mailing Address - Phone:503-892-3600
Mailing Address - Fax:503-892-3070
Practice Address - Street 1:1410 SW MARLOW AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5145
Practice Address - Country:US
Practice Address - Phone:503-892-3600
Practice Address - Fax:503-892-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R113079Medicare PIN