Healthcare Provider Details

I. General information

NPI: 1174564934
Provider Name (Legal Business Name): MILWAUKIE CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 SE INTERNATIONAL WAY
MILWAUKIE OR
97222
US

IV. Provider business mailing address

3716 SE INTERNATIONAL WAY
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-0073
  • Fax: 503-659-7471
Mailing address:
  • Phone: 503-659-0073
  • Fax: 503-659-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KEITH D JOHNS
Title or Position: PRESIDENT
Credential: DC PC
Phone: 503-659-0073