Healthcare Provider Details

I. General information

NPI: 1588596522
Provider Name (Legal Business Name): DR. WYATT MULHANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 MOLALLA AVE
OREGON CITY OR
97045-4004
US

IV. Provider business mailing address

1404 MOLALLA AVE
OREGON CITY OR
97045-4004
US

V. Phone/Fax

Practice location:
  • Phone: 503-723-4462
  • Fax:
Mailing address:
  • Phone: 503-723-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6517
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: