Healthcare Provider Details

I. General information

NPI: 1861832545
Provider Name (Legal Business Name): PACIFIC WEST CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 E MAIN ST
HILLSBORO OR
97123-7068
US

IV. Provider business mailing address

2820 E MAIN ST
HILLSBORO OR
97123-7068
US

V. Phone/Fax

Practice location:
  • Phone: 503-888-3967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5150
License Number StateOR

VIII. Authorized Official

Name: DR. KATIE M SILL
Title or Position: OWNER
Credential: DC, MS
Phone: 503-888-3967