Healthcare Provider Details

I. General information

NPI: 1164642658
Provider Name (Legal Business Name): HANS CHRISTIAN ANDERSEN CHIROPRACTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 SE MORRISON ST SUITE 245
PORTLAND OR
97214-6307
US

IV. Provider business mailing address

819 SE MORRISON ST SUITE 245
PORTLAND OR
97214-6307
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-6631
  • Fax: 503-234-9955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number3513
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: