Healthcare Provider Details

I. General information

NPI: 1164768818
Provider Name (Legal Business Name): TV HIGHWAY CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18055 SW TV HWY
ALOHA OR
97006-3953
US

IV. Provider business mailing address

18055 SW TV HWY
ALOHA OR
97006-3953
US

V. Phone/Fax

Practice location:
  • Phone: 503-642-3018
  • Fax:
Mailing address:
  • Phone: 503-642-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4091
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4091
License Number StateOR

VIII. Authorized Official

Name: DR. DUY N BUI
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 503-642-6018