Healthcare Provider Details

I. General information

NPI: 1962606178
Provider Name (Legal Business Name): DOLPHIN CHIROPRACTIC & ORTHOPEDIC PHYSICAL THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 CENTER DR SUITE 14
MEDFORD OR
97501-7908
US

IV. Provider business mailing address

1208 BEALL LN
CENTRAL POINT OR
97502-1573
US

V. Phone/Fax

Practice location:
  • Phone: 541-857-2678
  • Fax:
Mailing address:
  • Phone: 541-664-5151
  • Fax: 541-664-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number273291
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4197
License Number StateOR

VIII. Authorized Official

Name: MIVEN B DONATO
Title or Position: OWNER
Credential:
Phone: 541-664-5151