Provider Demographics
NPI:1992028435
Name:MCBRIDE, NICHOLAS RYAN (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RYAN
Last Name:MCBRIDE
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 1:715 SW MORRISON ST
Mailing Address - Street 2:SUITE 912
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3122
Mailing Address - Country:US
Mailing Address - Phone:503-488-5485
Mailing Address - Fax:503-488-5834
Practice Address - Street 1:715 SW MORRISON ST
Practice Address - Street 2:SUITE 912
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3122
Practice Address - Country:US
Practice Address - Phone:503-488-5485
Practice Address - Fax:503-488-5834
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4112OtherCHIROPRACTIC LISCENSE