Healthcare Provider Details

I. General information

NPI: 1295978963
Provider Name (Legal Business Name): NORTHWEST CHIROPRACTIC AND MEDICAL REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 NE 181ST AVE
PORTLAND OR
97230-6615
US

IV. Provider business mailing address

205 NE 181ST AVE
PORTLAND OR
97230-6615
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-1121
  • Fax:
Mailing address:
  • Phone: 305-467-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5121
License Number StateOR

VIII. Authorized Official

Name: DR. CARLOS HINOJOSA
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 305-467-1121