Healthcare Provider Details

I. General information

NPI: 1669661435
Provider Name (Legal Business Name): GERALD D. SMALLING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 PORTLAND RD
NEWBERG OR
97132-1362
US

IV. Provider business mailing address

2119 PORTLAND RD
NEWBERG OR
97132-1362
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-6134
  • Fax:
Mailing address:
  • Phone: 503-538-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3741
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: