Healthcare Provider Details

I. General information

NPI: 1447554340
Provider Name (Legal Business Name): BREANNE ALISA-DAWN RHODES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5482 SW ALGER AVE SUITE F14
BEAVERTON OR
97005-4369
US

IV. Provider business mailing address

PO BOX 525
WILSONVILLE OR
97070-0525
US

V. Phone/Fax

Practice location:
  • Phone: 971-209-2733
  • Fax:
Mailing address:
  • Phone: 971-209-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4076
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: