Provider Demographics
NPI:1184248726
Name:CHIROCENTRIC, LLC
Entity type:Organization
Organization Name:CHIROCENTRIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ALTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-430-7371
Mailing Address - Street 1:14355 SW ALLEN BLVD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4741
Mailing Address - Country:US
Mailing Address - Phone:503-806-5700
Mailing Address - Fax:877-940-4288
Practice Address - Street 1:14355 SW ALLEN BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4741
Practice Address - Country:US
Practice Address - Phone:503-806-5700
Practice Address - Fax:877-940-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty