Healthcare Provider Details

I. General information

NPI: 1710028782
Provider Name (Legal Business Name): LAVERNE ALDEN SABOE JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 19TH AVE SE
ALBANY OR
97322-4228
US

IV. Provider business mailing address

915 19TH AVE SE
ALBANY OR
97322-4228
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-3162
  • Fax: 541-928-2742
Mailing address:
  • Phone: 541-926-3162
  • Fax: 541-928-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1647
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: