Provider Demographics
NPI:1952944779
Name:SOUTHERN OREGON CHIROPRACTIC - KLAMATH FALLS
Entity Type:Organization
Organization Name:SOUTHERN OREGON CHIROPRACTIC - KLAMATH FALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND PROVIDER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-414-0362
Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-0006
Mailing Address - Country:US
Mailing Address - Phone:541-414-0362
Mailing Address - Fax:541-200-2269
Practice Address - Street 1:2650 WASHBURN WAY UNIT 180
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4591
Practice Address - Country:US
Practice Address - Phone:541-273-7120
Practice Address - Fax:541-273-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty