Healthcare Provider Details

I. General information

NPI: 1538327853
Provider Name (Legal Business Name): PACIFIC CHIROPRACTIC GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 NE SANDY BLVD STE 100B
PORTLAND OR
97213-7100
US

IV. Provider business mailing address

8040 NE SANDY BLVD STE 100B
PORTLAND OR
97213-7100
US

V. Phone/Fax

Practice location:
  • Phone: 503-249-7737
  • Fax: 503-249-9207
Mailing address:
  • Phone: 503-249-7737
  • Fax: 503-249-9207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: PETER VUKY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 503-249-7737