Provider Demographics
NPI:1982667937
Name:ADVANCED SPINAL FITNESS CHIR
Entity Type:Organization
Organization Name:ADVANCED SPINAL FITNESS CHIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-556-2353
Mailing Address - Street 1:PO BOX 1641
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-1641
Mailing Address - Country:US
Mailing Address - Phone:503-556-2353
Mailing Address - Fax:503-556-3065
Practice Address - Street 1:101 5TH ST WEST
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-1641
Practice Address - Country:US
Practice Address - Phone:503-556-2353
Practice Address - Fax:503-556-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134502Medicare UPIN
ORR134501Medicare PIN