Provider Demographics
NPI:1700157120
Name:TOWN CENTER CHIROPRACTIC
Entity Type:Organization
Organization Name:TOWN CENTER CHIROPRACTIC
Other - Org Name:STEVEN L SEBERS DC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-653-9697
Mailing Address - Street 1:8800 SE SUNNYSIDE ROAD
Mailing Address - Street 2:SUITE 214N
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:503-653-9697
Mailing Address - Fax:503-653-9691
Practice Address - Street 1:8800 SE SUNNYSIDE ROAD
Practice Address - Street 2:SUITE 214N
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5703
Practice Address - Country:US
Practice Address - Phone:503-653-9697
Practice Address - Fax:503-653-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2564111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR107362Medicare PIN