Provider Demographics
NPI:1245537521
Name:SOUTHERN OREGON SPORTS & SPINE PC
Entity type:Organization
Organization Name:SOUTHERN OREGON SPORTS & SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-482-0625
Mailing Address - Street 1:240 E HERSEY ST STE 0
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-5202
Mailing Address - Country:US
Mailing Address - Phone:541-482-0625
Mailing Address - Fax:541-482-3364
Practice Address - Street 1:240 E HERSEY ST STE 0
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-5202
Practice Address - Country:US
Practice Address - Phone:541-482-0625
Practice Address - Fax:541-482-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67707Medicare UPIN
ORR0000QGBWVMedicare PIN