Healthcare Provider Details

I. General information

NPI: 1891163515
Provider Name (Legal Business Name): ANDREW JOSEPH FUNK DC, DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 05/11/2025
Certification Date: 05/11/2025
Deactivation Date: 10/05/2022
Reactivation Date: 10/19/2022

III. Provider practice location address

5757 S MACADAM AVE STE 150
PORTLAND OR
97239-3789
US

IV. Provider business mailing address

5757 S MACADAM AVE STE 150
PORTLAND OR
97239-3789
US

V. Phone/Fax

Practice location:
  • Phone: 503-445-7999
  • Fax: 503-445-7997
Mailing address:
  • Phone: 503-445-7999
  • Fax: 503-445-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number5658
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: