Healthcare Provider Details

I. General information

NPI: 1679803043
Provider Name (Legal Business Name): BLUE MOUNTAIN CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SW 6TH ST
PENDLETON OR
97801-2026
US

IV. Provider business mailing address

424 SW 6TH ST
PENDLETON OR
97801-2026
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-1938
  • Fax: 541-276-7062
Mailing address:
  • Phone: 541-276-1938
  • Fax: 541-276-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2688
License Number StateOR

VIII. Authorized Official

Name: DR. MICHAEL JOHN MEGEHEE
Title or Position: OWNER
Credential: D.C.
Phone: 541-276-1938