Healthcare Provider Details

I. General information

NPI: 1326045626
Provider Name (Legal Business Name): HERESCO CHIROPRACTIC AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 NW 7TH ST
CORVALLIS OR
97330-6308
US

IV. Provider business mailing address

408 NW 7TH ST
CORVALLIS OR
97330-6308
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-9933
  • Fax: 541-757-7713
Mailing address:
  • Phone: 541-757-9933
  • Fax: 541-757-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27-1620
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number27-1620
License Number StateOR

VIII. Authorized Official

Name: DR. FRANK T HERESCO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 541-757-9933