Provider Demographics
NPI:1003390717
Name:CARESSA GULLIKSON, DC LLC
Entity type:Organization
Organization Name:CARESSA GULLIKSON, DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CARESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-941-4959
Mailing Address - Street 1:200 NE 20TH AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3094
Mailing Address - Country:US
Mailing Address - Phone:974-229-1384
Mailing Address - Fax:
Practice Address - Street 1:200 NE 20TH AVE STE 20
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3094
Practice Address - Country:US
Practice Address - Phone:974-229-1384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty