Healthcare Provider Details

I. General information

NPI: 1992835870
Provider Name (Legal Business Name): YAZVAC CHIROPRACTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 NE HALSEY ST
PORTLAND OR
97232-1522
US

IV. Provider business mailing address

2119 NE HALSEY ST
PORTLAND OR
97232-1522
US

V. Phone/Fax

Practice location:
  • Phone: 503-249-2121
  • Fax: 503-331-1069
Mailing address:
  • Phone: 503-249-2121
  • Fax: 503-331-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number27 3470
License Number StateOR

VIII. Authorized Official

Name: MS. DAWN L HEATER
Title or Position: OFFICE MANAGER
Credential:
Phone: 503-249-2121