Healthcare Provider Details

I. General information

NPI: 1821388687
Provider Name (Legal Business Name): BODIES IN BALANCE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 NW FAIRVIEW DR
GRESHAM OR
97030-3842
US

IV. Provider business mailing address

1748 NW FAIRVIEW DR
GRESHAM OR
97030-3842
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-3910
  • Fax: 503-674-6706
Mailing address:
  • Phone: 503-492-3910
  • Fax: 503-674-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number29961
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. TERI LYN GABRIEL
Title or Position: OWNER/ HEALTH CARE PROVIDER
Credential: DC
Phone: 503-492-3910