Healthcare Provider Details

I. General information

NPI: 1861663171
Provider Name (Legal Business Name): HEALTH HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 ALLEN CREEK RD SUITE 101
GRANTS PASS OR
97527-5820
US

IV. Provider business mailing address

1610 ALLEN CREEK RD SUITE 101
GRANTS PASS OR
97527-5820
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-9628
  • Fax: 541-479-4378
Mailing address:
  • Phone: 541-476-9628
  • Fax: 541-479-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS GILLILAND
Title or Position: OWNER/CHIROPRACTOR
Credential:
Phone: 541-476-9628