Healthcare Provider Details

I. General information

NPI: 1679635775
Provider Name (Legal Business Name): REBECCA RUTH SCHACKER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 NE 28TH AVE
PORTLAND OR
97232-3150
US

IV. Provider business mailing address

5308 SE RHONE ST
PORTLAND OR
97206-2962
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-0812
  • Fax: 503-233-9151
Mailing address:
  • Phone: 503-775-6885
  • Fax: 503-775-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3551
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: