Healthcare Provider Details

I. General information

NPI: 1043749658
Provider Name (Legal Business Name): DPRCHIRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8196 SW HALL BLVD STE 106
BEAVERTON OR
97008-4676
US

IV. Provider business mailing address

4330 SW 188TH AVE
BEAVERTON OR
97078-1517
US

V. Phone/Fax

Practice location:
  • Phone: 971-354-6916
  • Fax: 971-228-5438
Mailing address:
  • Phone: 971-354-6916
  • Fax: 971-228-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5768
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22330
License Number StateOR

VIII. Authorized Official

Name: DR. PAULA P RIVERA
Title or Position: MEMBER
Credential: DC, LMT
Phone: 971-354-6916