Provider Demographics
NPI:1336351592
Name:SALEM CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:SALEM CHIROPRACTIC CLINIC, PC
Other - Org Name:WSC CHIROPRACTIC PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-763-3528
Mailing Address - Street 1:1765 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4342
Mailing Address - Country:US
Mailing Address - Phone:503-763-3528
Mailing Address - Fax:503-763-3530
Practice Address - Street 1:1765 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4342
Practice Address - Country:US
Practice Address - Phone:503-763-3528
Practice Address - Fax:503-763-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty