Healthcare Provider Details

I. General information

NPI: 1720542749
Provider Name (Legal Business Name): TABOR SUN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 SW WASHINGTON AVE
BEAVERTON OR
97005-0530
US

IV. Provider business mailing address

4670 SW WASHINGTON AVE
BEAVERTON OR
97005-0530
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-8575
  • Fax: 503-526-0783
Mailing address:
  • Phone: 503-646-8575
  • Fax: 503-526-0783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ANDY CRUZ
Title or Position: OWNER
Credential: D.C.
Phone: 503-646-8575