Healthcare Provider Details

I. General information

NPI: 1003423914
Provider Name (Legal Business Name): EVERGREEN CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 NE HOOD AVE
GRESHAM OR
97030-7328
US

IV. Provider business mailing address

5920 BURMA RD
LAKE OSWEGO OR
97035-3240
US

V. Phone/Fax

Practice location:
  • Phone: 503-912-1156
  • Fax: 971-292-2932
Mailing address:
  • Phone: 971-330-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL JARED MANNS
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 503-912-1156