Provider Demographics
NPI:1801070891
Name:COMMUNITY CHIROPRACTIC AND EXERCISE MANAGEMENT
Entity type:Organization
Organization Name:COMMUNITY CHIROPRACTIC AND EXERCISE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-282-1114
Mailing Address - Street 1:1516 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3112
Mailing Address - Country:US
Mailing Address - Phone:503-282-1114
Mailing Address - Fax:
Practice Address - Street 1:1516 SE 43RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3112
Practice Address - Country:US
Practice Address - Phone:503-282-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD# 27 2908111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty