Healthcare Provider Details

I. General information

NPI: 1184248726
Provider Name (Legal Business Name): CHIROCENTRIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 01/11/2024
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14355 SW ALLEN BLVD. SUITE 150
BEAVERTON OR
97005-4741
US

IV. Provider business mailing address

14355 SW ALLEN BLVD. SUITE 150
BEAVERTON OR
97005-4741
US

V. Phone/Fax

Practice location:
  • Phone: 503-806-5700
  • Fax: 877-940-4288
Mailing address:
  • Phone: 503-806-5700
  • Fax: 877-940-4288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY DE ALTO
Title or Position: MANAGER/OWNER
Credential: D.C.
Phone: 503-430-7371