Healthcare Provider Details

I. General information

NPI: 1578847448
Provider Name (Legal Business Name): CHIROCARE CHIROPRACTIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 SE DIVISION ST STE 200
PORTLAND OR
97266-1353
US

IV. Provider business mailing address

10011 SE DIVISION ST STE 200
PORTLAND OR
97266-1353
US

V. Phone/Fax

Practice location:
  • Phone: 503-256-2654
  • Fax: 503-256-2493
Mailing address:
  • Phone: 503-256-2654
  • Fax: 503-256-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3852
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1248
License Number StateOR

VIII. Authorized Official

Name: RHONDA L HATHAWAY
Title or Position: SECRETARY
Credential:
Phone: 503-256-2654