Provider Demographics
NPI:1912492570
Name:SCAPPOOSE CHIRO CLINIC LLC
Entity Type:Organization
Organization Name:SCAPPOOSE CHIRO CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-987-4100
Mailing Address - Street 1:33608 E COLUMBIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3442
Mailing Address - Country:US
Mailing Address - Phone:503-987-4100
Mailing Address - Fax:503-987-4107
Practice Address - Street 1:33608 E COLUMBIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3442
Practice Address - Country:US
Practice Address - Phone:503-987-4100
Practice Address - Fax:503-987-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty