MEDICARE: DR. CAMMI VANCE DC, LMT

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	225700000X	Massage Therapist	6420	OR
2	111N00000X	Chiropractor	5821	OR

General Provider Information

NPI Number	:	1750622395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMMI VANCE DC, LMT

Provider Business Mailing Address
First Line	:	810 SE 26TH AVE APT B
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2997
Country	:	US
Telephone Number	:	503-753-7963
Fax Number	:

Provider Business Practice Location Address
First Line	:	16144 SE HAPPY VALLEY TOWN CENTER DR STE 214
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97086-4257
Country	:	US
Telephone Number	:	503-658-7715
Fax Number	:

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	07/21/2022

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