Provider Demographics
NPI:1932826823
Name:JOHN STADY
Entity Type:Organization
Organization Name:JOHN STADY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-644-3022
Mailing Address - Street 1:12775 SW BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2134
Mailing Address - Country:US
Mailing Address - Phone:503-644-3022
Mailing Address - Fax:503-644-3092
Practice Address - Street 1:12775 SW BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2134
Practice Address - Country:US
Practice Address - Phone:503-644-3022
Practice Address - Fax:503-644-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty