Healthcare Provider Details

I. General information

NPI: 1225399132
Provider Name (Legal Business Name): VALLEYVIEW CHIROPRACTIC & SPINE CENTER DBA GRESHAM CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 NE 2ND ST
GRESHAM OR
97030-7511
US

IV. Provider business mailing address

575 NE 2ND ST
GRESHAM OR
97030-7511
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-4531
  • Fax: 503-665-9997
Mailing address:
  • Phone: 503-666-4531
  • Fax: 503-665-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3564
License Number StateOR

VIII. Authorized Official

Name: DR. BENJAMIN LEE HEATH
Title or Position: OWNER
Credential: D.C.
Phone: 503-489-1998