Healthcare Provider Details

I. General information

NPI: 1871670588
Provider Name (Legal Business Name): RICHARD O BROUSE DC CLN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 SUNNYSIDE RD #111
CLACKAMAS OR
97015
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD #111
CLACKAMAS OR
97015
US

V. Phone/Fax

Practice location:
  • Phone: 503-654-3225
  • Fax: 503-654-3056
Mailing address:
  • Phone: 503-654-3225
  • Fax: 503-654-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number10333348
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number271359
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: