Healthcare Provider Details

I. General information

NPI: 1093984130
Provider Name (Legal Business Name): ADVANCED CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 E POWELL BLVD
GRESHAM OR
97030-7617
US

IV. Provider business mailing address

837 E POWELL BLVD
GRESHAM OR
97030-7617
US

V. Phone/Fax

Practice location:
  • Phone: 503-669-9495
  • Fax: 503-669-8257
Mailing address:
  • Phone: 503-669-9495
  • Fax: 503-669-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27-2936
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 VROOM
Title or Position: OWNER
Credential: D.C.
Phone: 503-358-1417