Healthcare Provider Details

I. General information

NPI: 1760428031
Provider Name (Legal Business Name): STEVE M KINGSTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: