Provider Demographics
NPI:1013117910
Name:CHRIS CHLEBOWSKI, INCORPORATED
Entity Type:Organization
Organization Name:CHRIS CHLEBOWSKI, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:CHLEBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-223-6414
Mailing Address - Street 1:2050 NW LOVEJOY ST
Mailing Address - Street 2:2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1670
Mailing Address - Country:US
Mailing Address - Phone:503-223-6414
Mailing Address - Fax:
Practice Address - Street 1:2050 NW LOVEJOY ST
Practice Address - Street 2:2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1670
Practice Address - Country:US
Practice Address - Phone:503-223-6414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71 3744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty