Healthcare Provider Details

I. General information

NPI: 1063403939
Provider Name (Legal Business Name): JOSEPH ANTHONY MEDLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 NE ALBERTA ST
PORTLAND OR
97211-5070
US

IV. Provider business mailing address

3327 NE 68TH AVE
PORTLAND OR
97213-5221
US

V. Phone/Fax

Practice location:
  • Phone: 503-788-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3305
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: