Healthcare Provider Details

I. General information

NPI: 1063494946
Provider Name (Legal Business Name): JOHN K LEGAT D.C, P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 WILLAGILLESPIE RD SUITE 10
EUGENE OR
97401-2142
US

IV. Provider business mailing address

3617 AMBLESIDE DR
SPRINGFIELD OR
97477-6736
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-4913
  • Fax: 541-343-5426
Mailing address:
  • Phone: 541-736-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number272750
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: