Provider Demographics
NPI:1013090067
Name:POON, WESLEY F (DC)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:F
Last Name:POON
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 1:11657 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2264
Mailing Address - Country:US
Mailing Address - Phone:971-801-8188
Mailing Address - Fax:503-287-0764
Practice Address - Street 1:11657 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2264
Practice Address - Country:US
Practice Address - Phone:971-801-8188
Practice Address - Fax:503-810-1164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3434111N00000X
WA60127216111NR0400X
OR273434111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor