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NPI Code Detail

MEDICARE: DR. GARY DAHLSTROM D.O.

MEDICARE: DR. GARY DAHLSTROM D.O.
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
1111N00000XChiropractor271734OR

General Provider Information

NPI Number : 1205981511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY DAHLSTROM D.O.
Provider Business Mailing Address
First Line : 1880 LANCASTER DR NE STE 103
Second Line :
City : SALEM
State : OR
Zip : 97305-1040
Country : US
Telephone Number : 503-585-4131
Fax Number :
Provider Business Practice Location Address
First Line : 1880 LANCASTER DR NE STE 103
Second Line :
City : SALEM
State : OR
Zip : 97305-1040
Country : US
Telephone Number : 503-585-4131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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Directions to “ DR. GARY DAHLSTROM D.O.” Practice Location

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