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NPI Code Detail

MEDICARE: CLACKAMETTE CHIROPRACTIC PC

MEDICARE: CLACKAMETTE CHIROPRACTIC PC
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
1111N00000XChiropractor273352OR

General Provider Information

NPI Number : 1326319351
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLACKAMETTE CHIROPRACTIC PC
Provider Business Mailing Address
First Line : 619 HIGH ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-2240
Country : US
Telephone Number : 503-656-4993
Fax Number : 503-657-0411
Provider Business Practice Location Address
First Line : 619 HIGH ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-2240
Country : US
Telephone Number : 503-656-4993
Fax Number : 503-657-0411
Authorized Official
Title or Position : OWNER
Name : DR. AMY LOREE EADES
Credential : DC
Telephone Number : 503-656-4993
Provider Enumeration Date : 01/23/2012
Last Update Date : 01/22/2013

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Directions to “CLACKAMETTE CHIROPRACTIC PC ” Practice Location

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