Healthcare Provider Details

I. General information

NPI: 1912860693
Provider Name (Legal Business Name): RESTORATION CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 15TH AVE STE D
EUGENE OR
97401-4177
US

IV. Provider business mailing address

1711 WILLAMETTE ST # 301-308
EUGENE OR
97401-4014
US

V. Phone/Fax

Practice location:
  • Phone: 541-512-4990
  • Fax: 541-897-9960
Mailing address:
  • Phone: 541-512-4990
  • Fax: 541-897-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN HAESE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 541-512-4990