Healthcare Provider Details

I. General information

NPI: 1881634293
Provider Name (Legal Business Name): BRUCE E ULRICH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 SE BASELINE ST SUITE D
HILLSBORO OR
97123-4149
US

IV. Provider business mailing address

13625 SW BERTHOLD ST
BEAVERTON OR
97005-4355
US

V. Phone/Fax

Practice location:
  • Phone: 503-330-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1528
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: