Healthcare Provider Details

I. General information

NPI: 1124897343
Provider Name (Legal Business Name): ALEXANDRA PCHENITCHNIKOVA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 SW 16TH AVE
PORTLAND OR
97205-1730
US

IV. Provider business mailing address

5240 SW 42ND AVE
PORTLAND OR
97221-3641
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-5000
  • Fax:
Mailing address:
  • Phone: 650-722-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6360
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: