Healthcare Provider Details

I. General information

NPI: 1649690660
Provider Name (Legal Business Name): CONTEMPORARY CHIROPRACTIC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9895 SE SUNNYSIDE RD SUITE L
CLACKAMAS OR
97015-5740
US

IV. Provider business mailing address

9895 SE SUNNYSIDE RD SUITE L
CLACKAMAS OR
97015-5740
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-0121
  • Fax: 503-659-0119
Mailing address:
  • Phone: 503-659-0121
  • Fax: 503-659-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1501
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. KIM D CHRISTENSEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 360-901-8800