Provider Demographics
NPI:1457537854
Name:HAWTHORN FARM ATHLETIC CLUB
Entity Type:Organization
Organization Name:HAWTHORN FARM ATHLETIC CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-640-6404
Mailing Address - Street 1:4800 NE BELKNAP CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6441
Mailing Address - Country:US
Mailing Address - Phone:503-640-6404
Mailing Address - Fax:503-640-0644
Practice Address - Street 1:4800 NE BELKNAP CT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6441
Practice Address - Country:US
Practice Address - Phone:503-640-6404
Practice Address - Fax:503-640-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty