Healthcare Provider Details

I. General information

NPI: 1952811408
Provider Name (Legal Business Name): PLASKER CHIROPRACTIC AND FUNCTIONAL NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SW CENTURY DR STE 104
BEND OR
97702-1657
US

IV. Provider business mailing address

61557 AARON WAY APT 3301
BEND OR
97702-8803
US

V. Phone/Fax

Practice location:
  • Phone: 458-206-3461
  • Fax: 458-206-3461
Mailing address:
  • Phone: 404-909-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5745
License Number StateOR

VIII. Authorized Official

Name: JACOB PLASKER
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 404-909-5764