Provider Demographics
NPI:1770612889
Name:CATALYST CHIROPRACTIC AND REHABILITATION PC
Entity type:Organization
Organization Name:CATALYST CHIROPRACTIC AND REHABILITATION PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-927-9250
Mailing Address - Street 1:3300 SW HOCKEN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2435
Mailing Address - Country:US
Mailing Address - Phone:503-526-8782
Mailing Address - Fax:503-526-8721
Practice Address - Street 1:3300 SW HOCKEN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2435
Practice Address - Country:US
Practice Address - Phone:503-526-8782
Practice Address - Fax:503-526-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty