Healthcare Provider Details

I. General information

NPI: 1285167163
Provider Name (Legal Business Name): ACCIDENT CARE CHIROPRACTIC AND MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 E POWELL BLVD
GRESHAM OR
97030-7616
US

IV. Provider business mailing address

790 E POWELL BLVD
GRESHAM OR
97030-7616
US

V. Phone/Fax

Practice location:
  • Phone: 503-660-8552
  • Fax:
Mailing address:
  • Phone: 503-660-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4063
License Number StateOR

VIII. Authorized Official

Name: DARREN FAHERTY
Title or Position: OWNER
Credential: DC
Phone: 503-660-8552