Healthcare Provider Details

I. General information

NPI: 1003779224
Provider Name (Legal Business Name): SPENCER TORO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N KILLINGSWORTH ST
PORTLAND OR
97217-2435
US

IV. Provider business mailing address

2625 E BURNSIDE ST APT 234
PORTLAND OR
97214-1872
US

V. Phone/Fax

Practice location:
  • Phone: 503-288-4454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6490
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: