Healthcare Provider Details

I. General information

NPI: 1003132408
Provider Name (Legal Business Name): DANIEL ANTONIO LUJAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 SW CORBETT AVE
PORTLAND OR
97239-4260
US

IV. Provider business mailing address

4425 SW CORBETT AVE
PORTLAND OR
97239-4260
US

V. Phone/Fax

Practice location:
  • Phone: 503-225-9033
  • Fax: 503-225-9039
Mailing address:
  • Phone: 503-225-9033
  • Fax: 503-225-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4013
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number4013
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number4013
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number4013
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number4013
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4013
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4013
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number4013
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: