Provider Demographics
NPI:1669802617
Name:CLOCK TOWER CHIROPRACTIC & MASSAGE PC
Entity type:Organization
Organization Name:CLOCK TOWER CHIROPRACTIC & MASSAGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCICPLE OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-685-9841
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-0966
Mailing Address - Country:US
Mailing Address - Phone:503-685-9841
Mailing Address - Fax:503-682-9069
Practice Address - Street 1:8642 SW MAIN ST
Practice Address - Street 2:SUITE #130
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6585
Practice Address - Country:US
Practice Address - Phone:503-685-9841
Practice Address - Fax:503-682-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134000OtherMEDICARE PTAN
ORR134000OtherMEDICARE PTAN