Healthcare Provider Details

I. General information

NPI: 1174841175
Provider Name (Legal Business Name): INNER-BALANCE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22400 SE STARK ST
GRESHAM OR
97030-2656
US

IV. Provider business mailing address

3021 SE PHEASANT AVE
GRESHAM OR
97080-8260
US

V. Phone/Fax

Practice location:
  • Phone: 503-907-0100
  • Fax: 503-907-0098
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3988
License Number StateOR

VIII. Authorized Official

Name: DR. MILKAKA STRINGHAM
Title or Position: OWNER
Credential: DC
Phone: 503-907-0100