Provider Demographics
NPI:1932579661
Name:STRAIGHT UP CHIROPRACTIC
Entity Type:Organization
Organization Name:STRAIGHT UP CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HALSY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-716-8281
Mailing Address - Street 1:12700 SW NORTH DAKOTA ST
Mailing Address - Street 2:STE 180
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3276
Mailing Address - Country:US
Mailing Address - Phone:503-716-8281
Mailing Address - Fax:503-716-8783
Practice Address - Street 1:12700 SW NORTH DAKOTA ST
Practice Address - Street 2:STE 180
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-0802
Practice Address - Country:US
Practice Address - Phone:503-716-8281
Practice Address - Fax:503-716-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5126261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service