Healthcare Provider Details

I. General information

NPI: 1265475172
Provider Name (Legal Business Name): WENDY BRACKEEN DC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY KNIGHT DC

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NE 2ND AVE STE 1
HILLSBORO OR
97124-3074
US

IV. Provider business mailing address

230 NE 2ND AVE STE 1
HILLSBORO OR
97124-3074
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-2800
  • Fax:
Mailing address:
  • Phone: 503-640-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5151
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: