Healthcare Provider Details

I. General information

NPI: 1467628735
Provider Name (Legal Business Name): DR SURAH HIRSCH DC & ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 NE SANDY BLVD STE. 200
PORTLAND OR
97232-2500
US

IV. Provider business mailing address

3151 NE SANDY BLVD STE. 200
PORTLAND OR
97232-2500
US

V. Phone/Fax

Practice location:
  • Phone: 503-238-9788
  • Fax: 503-233-9163
Mailing address:
  • Phone: 503-238-9788
  • Fax: 503-233-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberOR 2037
License Number StateOR

VIII. Authorized Official

Name: DR. SURAH HIRSCH
Title or Position: OWNER
Credential: D.C.
Phone: 503-238-9788