Healthcare Provider Details

I. General information

NPI: 1730363920
Provider Name (Legal Business Name): GEBO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 SW HALL BLVD
BEAVERTON OR
97008-6446
US

IV. Provider business mailing address

8118 SW HALL BLVD
BEAVERTON OR
97008-6446
US

V. Phone/Fax

Practice location:
  • Phone: 503-469-9824
  • Fax: 503-469-9324
Mailing address:
  • Phone: 503-469-9824
  • Fax: 503-469-9324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number271452
License Number StateOR

VIII. Authorized Official

Name: MS. DAVIREE DANAHER
Title or Position: OFFICE MANAGER/ BILLING
Credential:
Phone: 503-469-9824