Healthcare Provider Details

I. General information

NPI: 1558971481
Provider Name (Legal Business Name): CHRISTOPHER GOSSELIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5167 RIVER RD N
KEIZER OR
97303-5349
US

IV. Provider business mailing address

5167 RIVER RD N
KEIZER OR
97303-5349
US

V. Phone/Fax

Practice location:
  • Phone: 503-990-7054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number6091
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: