Healthcare Provider Details

I. General information

NPI: 1740985076
Provider Name (Legal Business Name): NICHOLAS MCCRORY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17449 BOONES FERRY RD STE 300
LAKE OSWEGO OR
97035-6209
US

IV. Provider business mailing address

6950 NE CHERRY DR APT E106
HILLSBORO OR
97124-7749
US

V. Phone/Fax

Practice location:
  • Phone: 503-850-4526
  • Fax:
Mailing address:
  • Phone: 805-268-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6286
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: