Healthcare Provider Details

I. General information

NPI: 1487786026
Provider Name (Legal Business Name): SETH CALLAGHAN ALLEY DC, CCSP, CKTP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 SW WESTGATE DR SUITE 100
PORTLAND OR
97221-2420
US

IV. Provider business mailing address

5440 SW WESTGATE DR SUITE 100
PORTLAND OR
97221-2420
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-4447
  • Fax: 503-296-8414
Mailing address:
  • Phone: 503-297-4447
  • Fax: 503-296-8414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number713668
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number713668
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: