Healthcare Provider Details

I. General information

NPI: 1184790073
Provider Name (Legal Business Name): HILLCREST CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 NE HOOD AVE
GRESHAM OR
97030-7449
US

IV. Provider business mailing address

329 NE HOOD AVE
GRESHAM OR
97030-7449
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-0388
  • Fax: 503-491-0784
Mailing address:
  • Phone: 503-491-0388
  • Fax: 503-491-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number4394
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number27-3110
License Number StateOR

VIII. Authorized Official

Name: DR. RYAN M THOMAS
Title or Position: LLC MEMBER
Credential: DC, DABCO
Phone: 503-491-0388