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NPI Code Detail

MEDICARE: PHILIP A. DEVASTO D.C.

MEDICARE: PHILIP A. DEVASTO 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
1111N00000XChiropractor4081OR

General Provider Information

NPI Number : 1548566227
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP A. DEVASTO D.C.
Provider Business Mailing Address
First Line : 4817 SW HUMPHREY PARK CRST
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2333
Country : US
Telephone Number : 617-365-1527
Fax Number :
Provider Business Practice Location Address
First Line : 16679 BOONES FERRY RD STE 105
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-4378
Country : US
Telephone Number : 503-635-6005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2011
Last Update Date : 11/15/2023

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Directions to “ PHILIP A. DEVASTO D.C.” Practice Location

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