Healthcare Provider Details

I. General information

NPI: 1780853283
Provider Name (Legal Business Name): ZANE R GARD JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15220 NW GREENBRIER PARKWAY, SUITE 260
BEAVERTON OR
97006
US

IV. Provider business mailing address

15220 NW GREENBRIER PARKWAY, SUITE 260
BEAVERTON OR
97006
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9494
  • Fax: 503-645-4404
Mailing address:
  • Phone: 503-439-9494
  • Fax: 503-645-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number273244
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: