Healthcare Provider Details

I. General information

NPI: 1164162020
Provider Name (Legal Business Name): TERRY YCASAS, DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SE 11TH AVE
PORTLAND OR
97214-2469
US

IV. Provider business mailing address

716 SE 11TH AVE
PORTLAND OR
97214-2469
US

V. Phone/Fax

Practice location:
  • Phone: 503-866-4680
  • Fax:
Mailing address:
  • Phone: 503-866-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY YCASAS
Title or Position: OWNER
Credential: DC
Phone: 503-866-4680