Provider Demographics
NPI:1912563446
Name:PINNACLE CHIROPRACTIC WELLNESS LLC
Entity Type:Organization
Organization Name:PINNACLE CHIROPRACTIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, CCSP
Authorized Official - Phone:503-746-5667
Mailing Address - Street 1:17020 SW UPPER BOONES FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7078
Mailing Address - Country:US
Mailing Address - Phone:503-746-5667
Mailing Address - Fax:503-210-1110
Practice Address - Street 1:17020 SW UPPER BOONES FERRY RD STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7078
Practice Address - Country:US
Practice Address - Phone:503-746-5667
Practice Address - Fax:503-210-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty