Healthcare Provider Details

I. General information

NPI: 1639367956
Provider Name (Legal Business Name): STEVE M KINGSTON DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 SE HAWTHORNE BLVD
PORTLAND OR
97215-3162
US

IV. Provider business mailing address

4351 SE HAWTHORNE BLVD
PORTLAND OR
97215-3162
US

V. Phone/Fax

Practice location:
  • Phone: 503-236-1528
  • Fax: 503-236-3701
Mailing address:
  • Phone: 503-236-1528
  • Fax: 503-236-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2039
License Number StateOR

VIII. Authorized Official

Name: DR. STEVE M KINGSTON
Title or Position: OWNER
Credential: DC
Phone: 503-236-1528