Healthcare Provider Details

I. General information

NPI: 1225231566
Provider Name (Legal Business Name): ANTHONY NHUT PHAM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 RIVER RD N
KEIZER OR
97303-4803
US

IV. Provider business mailing address

12661 SE POWELL BLVD SUITE B
PORTLAND OR
97236-3400
US

V. Phone/Fax

Practice location:
  • Phone: 503-463-6131
  • Fax: 503-463-6138
Mailing address:
  • Phone: 503-801-8888
  • Fax: 503-477-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number713737
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: