Provider Demographics
NPI:1922608819
Name:SUMMIT CHIROPRACTIC HOLDING LLC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC HOLDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-705-7477
Mailing Address - Street 1:21400 SALAMO RD
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7201
Mailing Address - Country:US
Mailing Address - Phone:503-650-2487
Mailing Address - Fax:503-650-4382
Practice Address - Street 1:21400 SALAMO RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7201
Practice Address - Country:US
Practice Address - Phone:503-650-2487
Practice Address - Fax:503-650-4382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMERON JOHNSON DC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty