Provider Demographics
NPI:1720264955
Name:CENTRAL OREGON CHIROPRACTIC SERVICE PC
Entity Type:Organization
Organization Name:CENTRAL OREGON CHIROPRACTIC SERVICE PC
Other - Org Name:MADRAS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-475-6171
Mailing Address - Street 1:28 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1827
Mailing Address - Country:US
Mailing Address - Phone:541-475-6171
Mailing Address - Fax:541-475-6172
Practice Address - Street 1:28 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1827
Practice Address - Country:US
Practice Address - Phone:541-475-6171
Practice Address - Fax:541-475-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271654111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269480Medicaid
ORT67940Medicare UPIN