Healthcare Provider Details

I. General information

NPI: 1598057309
Provider Name (Legal Business Name): GERVAIS CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 RIVER RD
EUGENE OR
97404-3242
US

IV. Provider business mailing address

1029 RIVER RD
EUGENE OR
97404-3242
US

V. Phone/Fax

Practice location:
  • Phone: 541-543-5032
  • Fax:
Mailing address:
  • Phone: 541-543-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3834
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. BRIAN D GERVAIS
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 541-543-5032