Healthcare Provider Details

I. General information

NPI: 1346447166
Provider Name (Legal Business Name): DDN ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 SW 109TH AVE
BEAVERTON OR
97005-3028
US

IV. Provider business mailing address

4265 SW 109TH AVE
BEAVERTON OR
97005-3028
US

V. Phone/Fax

Practice location:
  • Phone: 503-526-8600
  • Fax: 503-643-1006
Mailing address:
  • Phone: 503-526-8600
  • Fax: 503-643-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number273359
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1419
License Number StateOR

VIII. Authorized Official

Name: DR. DENNIS ALLEN NOWACK
Title or Position: OWNER
Credential: D.C.
Phone: 503-526-8600