Healthcare Provider Details

I. General information

NPI: 1346862802
Provider Name (Legal Business Name): ROCKWOOD CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 SE 182ND AVE
GRESHAM OR
97030-5058
US

IV. Provider business mailing address

4322 SE 182ND AVE
GRESHAM OR
97030-5058
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 Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LEE P COWAN
Title or Position: PRESIDENT
Credential: PC
Phone: 503-667-8988