Provider Demographics
NPI:1770788028
Name:CONKLIN, PAULA L (DC)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:L
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 NE KNOTT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3131
Mailing Address - Country:US
Mailing Address - Phone:503-287-6199
Mailing Address - Fax:503-287-0210
Practice Address - Street 1:707 NE KNOTT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3131
Practice Address - Country:US
Practice Address - Phone:503-287-6199
Practice Address - Fax:503-287-0210
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR169744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116889Medicare ID - Type Unspecified