Healthcare Provider Details

I. General information

NPI: 1134726417
Provider Name (Legal Business Name): LOGAN CHAVEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NW WALL ST STE 100
BEND OR
97703-3200
US

IV. Provider business mailing address

1807 NW JACKPINE AVE
REDMOND OR
97756-8459
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-4321
  • Fax: 541-389-4420
Mailing address:
  • Phone: 360-601-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6510
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: