Healthcare Provider Details

I. General information

NPI: 1326180969
Provider Name (Legal Business Name): DANSAR LTD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27 2936
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number71 3666
License Number StateOR

VIII. Authorized Official

Name: DR. BRIAN L VROOM
Title or Position: PRESIDENT, CHIROPRACTOR
Credential: D.C.
Phone: 503-669-9495