MEDICARE: WISE CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1104600113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	522 NW 12TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-3001
Country	:	US
Telephone Number	:	503-227-2886
Fax Number	:	503-790-1004

Provider Business Practice Location Address
First Line	:	522 NW 12TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-3001
Country	:	US
Telephone Number	:	503-227-2886
Fax Number	:	503-790-1004

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS ALEXANDER WISE
Credential	:	D.C.
Telephone Number	:	971-864-1972

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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Directions to “WISE CHIROPRACTIC, LLC ” Practice Location

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