Healthcare Provider Details

I. General information

NPI: 1770934812
Provider Name (Legal Business Name): CHIROBIZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 11/15/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12325 SW HORIZON BLVD SUITE 223
BEAVERTON OR
97007-9474
US

IV. Provider business mailing address

2425 SW WEST WIND DR
MCMINNVILLE OR
97128-7006
US

V. Phone/Fax

Practice location:
  • Phone: 847-309-3350
  • Fax:
Mailing address:
  • Phone: 847-309-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5569
License Number StateOR

VIII. Authorized Official

Name: DR. KATHRYN RAE CANTWELL
Title or Position: OWNER
Credential: DC
Phone: 847-309-3350