Provider Demographics
NPI:1922137801
Name:SELLERS, LAWRENCE TIMOTHY (DC DACBR)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:TIMOTHY
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DC DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-236-6547
Mailing Address - Fax:
Practice Address - Street 1:2442 SE 101ST AVE
Practice Address - Street 2:STE 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216
Practice Address - Country:US
Practice Address - Phone:503-257-2888
Practice Address - Fax:503-257-2889
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272107111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T92907Medicare UPIN
OR111833Medicare ID - Type Unspecified