Healthcare Provider Details

I. General information

NPI: 1235379108
Provider Name (Legal Business Name): CHIROPRACTIC AND ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW BETHANY BL. STE. 200
BEAVERTON OR
97006-5236
US

IV. Provider business mailing address

1500 NW BETHANY BL. STE. 200
BEAVERTON OR
97006-5236
US

V. Phone/Fax

Practice location:
  • Phone: 503-597-7780
  • Fax: 503-597-1301
Mailing address:
  • Phone: 503-597-7780
  • Fax: 503-597-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3904
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01256
License Number StateOR

VIII. Authorized Official

Name: DR. LAUREL LEIGH JOHNSON
Title or Position: OWNER
Credential: D.C., L.AC.
Phone: 503-597-7780