Healthcare Provider Details

I. General information

NPI: 1700157120
Provider Name (Legal Business Name): TOWN CENTER CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 SE SUNNYSIDE ROAD SUITE 214N
CLACKAMAS OR
97015-5703
US

IV. Provider business mailing address

8800 SE SUNNYSIDE ROAD SUITE 214N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 503-653-9697
  • Fax: 503-653-9691
Mailing address:
  • Phone: 503-653-9697
  • Fax: 503-653-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2564
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. LEANNA R GOURLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 503-653-9697