Healthcare Provider Details

I. General information

NPI: 1306116694
Provider Name (Legal Business Name): MCMINNVILLE CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 NE EVANS ST
MCMINNVILLE OR
97128-3925
US

IV. Provider business mailing address

723 NE EVANS ST
MCMINNVILLE OR
97128-3925
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-9002
  • Fax:
Mailing address:
  • Phone: 503-434-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2958
License Number StateOR

VIII. Authorized Official

Name: DR. PETER WILLIAM ANDERSON
Title or Position: OWNER
Credential: DC
Phone: 503-434-9002