Provider Demographics
NPI:1013438829
Name:OREGON SPORTS AND FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:OREGON SPORTS AND FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRANDEN
Authorized Official - Last Name:GARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:503-554-0022
Mailing Address - Street 1:434 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1855
Mailing Address - Country:US
Mailing Address - Phone:503-554-0022
Mailing Address - Fax:503-554-0033
Practice Address - Street 1:434 VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1855
Practice Address - Country:US
Practice Address - Phone:503-554-0022
Practice Address - Fax:503-554-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5042111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500756865Medicaid