Provider Demographics
NPI:1841333135
Name:CANYONVILLE CHIROPRACTIC INC
Entity type:Organization
Organization Name:CANYONVILLE CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CANYONVILLE CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-839-4421
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:CANYONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97417
Mailing Address - Country:US
Mailing Address - Phone:541-839-4421
Mailing Address - Fax:541-839-6080
Practice Address - Street 1:134 SE 3RD STREET
Practice Address - Street 2:
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417
Practice Address - Country:US
Practice Address - Phone:541-839-4421
Practice Address - Fax:541-839-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R109231Medicare UPIN
8009330614Medicare ID - Type Unspecified