Healthcare Provider Details

I. General information

NPI: 1316987720
Provider Name (Legal Business Name): JOHN CHARLES FOLAND DC, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 NE SANDY BLVD
PORTLAND OR
97232-2342
US

IV. Provider business mailing address

2608 NE SANDY BLVD
PORTLAND OR
97232-2342
US

V. Phone/Fax

Practice location:
  • Phone: 503-282-8582
  • Fax: 503-460-0814
Mailing address:
  • Phone: 503-719-4326
  • Fax: 503-719-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number27 3262
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: