Provider Demographics
NPI:1972194769
Name:MORELAND, CASSANDRA (DC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MORELAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15523 SE RIVER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-3503
Mailing Address - Country:US
Mailing Address - Phone:503-528-6603
Mailing Address - Fax:
Practice Address - Street 1:6650 SW REDWOOD LN STE 105
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7184
Practice Address - Country:US
Practice Address - Phone:503-567-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6132111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor