Healthcare Provider Details

I. General information

NPI: 1073695003
Provider Name (Legal Business Name): ROCKWOOD CHIROPRACTIC CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 SE 182ND AVE
GRESHAM OR
97030
US

IV. Provider business mailing address

4322 SE 182ND AVE
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-8988
  • Fax: 503-667-8976
Mailing address:
  • Phone: 503-667-8988
  • Fax: 503-667-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number271566
License Number StateOR

VIII. Authorized Official

Name: DR. LEE P COWAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 503-667-8988