Healthcare Provider Details

I. General information

NPI: 1083686836
Provider Name (Legal Business Name): FRED SEATER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SE HARRISON ST
MILWAUKIE OR
97222-5859
US

IV. Provider business mailing address

16280 S APPERSON BLVD
OREGON CITY OR
97045-1102
US

V. Phone/Fax

Practice location:
  • Phone: 503-653-2232
  • Fax:
Mailing address:
  • Phone: 503-656-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3595
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: