Healthcare Provider Details

I. General information

NPI: 1770732265
Provider Name (Legal Business Name): SULIS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NW VAUGHN ST SUITE 154
PORTLAND OR
97210-5311
US

IV. Provider business mailing address

2701 NW VAUGHN ST SUITE 154
PORTLAND OR
97210-5311
US

V. Phone/Fax

Practice location:
  • Phone: 503-719-4326
  • Fax: 503-719-4328
Mailing address:
  • Phone: 503-719-4326
  • Fax: 503-719-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3308
License Number StateOR

VIII. Authorized Official

Name: JOHN CHARLES FOLAND
Title or Position: CO-OPERATING MANAGER
Credential: DC, CCSP
Phone: 503-719-4326