MEDICARE: DR. ANDREW ALVIS D.C.

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	3894	OR

General Provider Information

NPI Number	:	1134407463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW ALVIS D.C.

Provider Business Mailing Address
First Line	:	2916 NE BROADWAY ST
Second Line	:	SUITE B
City	:	PORTLAND
State	:	OR
Zip	:	97232-1897
Country	:	US
Telephone Number	:	503-477-4230
Fax Number	:	503-946-8306

Provider Business Practice Location Address
First Line	:	2916 NE BROADWAY ST
Second Line	:	SUITE B
City	:	PORTLAND
State	:	OR
Zip	:	97232-1897
Country	:	US
Telephone Number	:	503-477-4230
Fax Number	:	503-946-8306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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