Provider Demographics
NPI:1184406738
Name:GREGORY OLTMANN DC LLC
Entity type:Organization
Organization Name:GREGORY OLTMANN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:OLTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-888-1314
Mailing Address - Street 1:12700 SW NORTH DAKOTA ST STE 180
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-0802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12700 SW NORTH DAKOTA ST STE 180
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-0802
Practice Address - Country:US
Practice Address - Phone:503-716-8281
Practice Address - Fax:503-716-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty