Provider Demographics
NPI:1700445210
Name:ACEVEDO, RUBEN III (DC, MS, MA)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:ACEVEDO
Suffix:III
Gender:M
Credentials:DC, MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 NE SISKIYOU ST APT 11
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1657
Mailing Address - Country:US
Mailing Address - Phone:939-280-1858
Mailing Address - Fax:
Practice Address - Street 1:19125 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5748
Practice Address - Country:US
Practice Address - Phone:503-328-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor