MEDICARE: DR. PATRICK IABONI D.C., B.SC.

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	111NR0400X	Rehabilitation Chiropractor	71-3327	OR
2	111NS0005X	Sports Physician Chiropractor	71-3327	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376614453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK IABONI D.C., B.SC.

Provider Business Mailing Address
First Line	:	1609 WILLAMETTE FALLS DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-4544
Country	:	US
Telephone Number	:	503-656-1943
Fax Number	:	503-650-5808

Provider Business Practice Location Address
First Line	:	1609 WILLAMETTE FALLS DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-4544
Country	:	US
Telephone Number	:	503-656-1943
Fax Number	:	503-650-5808

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	05/08/2008

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