Healthcare Provider Details

I. General information

NPI: 1902964729
Provider Name (Legal Business Name): ELIZABETH DELPLATO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SE STARK ST SUITE 201B
GRESHAM OR
97030-3331
US

IV. Provider business mailing address

25500 SE STARK ST SUITE 201B
GRESHAM OR
97030-3331
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-9491
  • Fax:
Mailing address:
  • Phone: 503-667-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number272820
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: