Healthcare Provider Details

I. General information

NPI: 1588987473
Provider Name (Legal Business Name): PHILLIP MCCARY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 E BURNSIDE ST STE 213
PORTLAND OR
97214-1768
US

IV. Provider business mailing address

2705 E BURNSIDE ST STE 213
PORTLAND OR
97214-1768
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-4288
  • Fax: 503-234-8613
Mailing address:
  • Phone: 503-234-4288
  • Fax: 503-234-8613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4044
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: