Healthcare Provider Details

I. General information

NPI: 1568497717
Provider Name (Legal Business Name): DOUGLAS ROSS PORTMANN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WARDS CORNER RD SUITE 101
LOVELAND OH
45140-6148
US

IV. Provider business mailing address

6321 PINE COVE LN
LOVELAND OH
45140-5801
US

V. Phone/Fax

Practice location:
  • Phone: 513-677-6787
  • Fax: 513-677-2260
Mailing address:
  • Phone: 513-697-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: