Provider Demographics
NPI:1740476936
Name:OVERLAND, VENCIL J (DC)
Entity type:Individual
Prefix:DR
First Name:VENCIL
Middle Name:J
Last Name:OVERLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NE DIVISION ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3544
Mailing Address - Country:US
Mailing Address - Phone:541-382-3563
Mailing Address - Fax:541-317-5910
Practice Address - Street 1:2600 NE DIVISION ST STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3544
Practice Address - Country:US
Practice Address - Phone:541-382-3563
Practice Address - Fax:541-317-5910
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor