Provider Demographics
NPI:1972830685
Name:TYRONE WEI, D.C., D.A.C.B.R., L.L.C
Entity Type:Organization
Organization Name:TYRONE WEI, D.C., D.A.C.B.R., L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACBR
Authorized Official - Phone:503-254-7237
Mailing Address - Street 1:15755 SW SEQUOIA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7166
Mailing Address - Country:US
Mailing Address - Phone:503-254-7237
Mailing Address - Fax:503-639-9710
Practice Address - Street 1:15755 SW SEQUOIA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7166
Practice Address - Country:US
Practice Address - Phone:503-254-7237
Practice Address - Fax:503-639-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271493111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR194560900OtherU.S. DEPT. OF LABOR
OR23690OtherREGENCE BLUE CROSS
OR17626OtherSAIF
WA28250OtherDEPT. OF LABOR & INDUSTRIES
OR271536Medicaid
OR589238OtherODS
WA28250OtherDEPT. OF LABOR & INDUSTRIES
OR271536Medicaid