Healthcare Provider Details

I. General information

NPI: 1386369429
Provider Name (Legal Business Name): 100 CHIRO PADILLA TRAN PC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 MERCANTILE DR STE 105
LAKE OSWEGO OR
97035-2518
US

IV. Provider business mailing address

4025 MERCANTILE DR STE 105
LAKE OSWEGO OR
97035-2518
US

V. Phone/Fax

Practice location:
  • Phone: 503-459-1526
  • Fax:
Mailing address:
  • Phone: 503-459-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCIA PADILLA
Title or Position: OWNER
Credential:
Phone: 704-507-0938