Provider Demographics
NPI:1962866244
Name:SHAMLOO, BEJIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BEJIAN
Middle Name:
Last Name:SHAMLOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 SW EASTRIDGE ST.
Mailing Address - Street 2:SUITE 235
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:971-302-6373
Mailing Address - Fax:
Practice Address - Street 1:10200 SW EASTRIDGE ST.
Practice Address - Street 2:SUITE 235
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:971-302-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor